Provider Demographics
NPI:1508278623
Name:AUSTIN FOOT & ANKLE CONSULTANTS PLLC
Entity Type:Organization
Organization Name:AUSTIN FOOT & ANKLE CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ARNALDO
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-649-3166
Mailing Address - Street 1:PO BOX 49547
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-9547
Mailing Address - Country:US
Mailing Address - Phone:512-649-3166
Mailing Address - Fax:877-528-6642
Practice Address - Street 1:4316 JAMES CASEY ST
Practice Address - Street 2:BLDG. F, STE. 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1116
Practice Address - Country:US
Practice Address - Phone:512-649-3166
Practice Address - Fax:877-528-6642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1937213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217754501Medicaid
TXB107458OtherMEDICARE PROVIDER NUMBER
1902864333OtherPROVIDER INDIVIDUAL NPI NUMBER
TX217754501Medicaid