Provider Demographics
NPI:1497107734
Name:WICHITA FALLS PODIATRY, PLLC
Entity Type:Organization
Organization Name:WICHITA FALLS PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATCHARABHORN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLUMB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-882-5144
Mailing Address - Street 1:3510 RUGBY LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1721
Mailing Address - Country:US
Mailing Address - Phone:216-882-5144
Mailing Address - Fax:
Practice Address - Street 1:3510 RUGBY LN
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1721
Practice Address - Country:US
Practice Address - Phone:216-882-5144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2216261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric