Provider Demographics
NPI:1497925978
Name:FAMILY FOOT CENTER, PLLC
Entity Type:Organization
Organization Name:FAMILY FOOT CENTER, PLLC
Other - Org Name:FAMILY FOOT CENTER, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:281-937-0077
Mailing Address - Street 1:PO BOX 16903
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-6903
Mailing Address - Country:US
Mailing Address - Phone:281-937-0077
Mailing Address - Fax:
Practice Address - Street 1:16659 SOUTHWEST FWY
Practice Address - Street 2:201
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2375
Practice Address - Country:US
Practice Address - Phone:281-937-0077
Practice Address - Fax:877-231-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1382332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4638610001Medicare NSC