Provider Demographics
NPI:1558577098
Name:LONESTAR PODIATRY & SURGERY PA
Entity Type:Organization
Organization Name:LONESTAR PODIATRY & SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BORCHERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:210-445-0300
Mailing Address - Street 1:1229 RIVER TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:PIPE CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:78063-5960
Mailing Address - Country:US
Mailing Address - Phone:210-445-0300
Mailing Address - Fax:210-224-7007
Practice Address - Street 1:730 N MAIN AVE
Practice Address - Street 2:SUITE 819
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1152
Practice Address - Country:US
Practice Address - Phone:210-445-0300
Practice Address - Fax:210-224-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1591213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613038Medicare PIN