Provider Demographics
NPI:1497937759
Name:CODWELL FAMILY FOOT CENTER, PA
Entity Type:Organization
Organization Name:CODWELL FAMILY FOOT CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ELIHUE
Authorized Official - Last Name:CODWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-526-0600
Mailing Address - Street 1:6655 TRAVIS ST STE 840
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1342
Mailing Address - Country:US
Mailing Address - Phone:713-526-0600
Mailing Address - Fax:713-526-7121
Practice Address - Street 1:6655 TRAVIS ST STE 840
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1342
Practice Address - Country:US
Practice Address - Phone:713-526-0600
Practice Address - Fax:713-526-7121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1279213ES0103X
TX4876770001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092835002Medicaid
TXU55376Medicare UPIN
TX00R83MMedicare PIN