Provider Demographics
NPI:1568563559
Name:ADVANCED DIAGNOSTIC FOOT & ANKLE SPECIALISTS OF GREATER HOUSTON PLLC
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTIC FOOT & ANKLE SPECIALISTS OF GREATER HOUSTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:IRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:PMAC
Authorized Official - Phone:281-579-5670
Mailing Address - Street 1:21720 KINGSLAND BLVD
Mailing Address - Street 2:SUITE 303B
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2550
Mailing Address - Country:US
Mailing Address - Phone:281-579-5670
Mailing Address - Fax:281-579-5671
Practice Address - Street 1:21720 KINGSLAND BLVD
Practice Address - Street 2:SUITE 303B
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2550
Practice Address - Country:US
Practice Address - Phone:281-579-5670
Practice Address - Fax:281-579-5671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6356410001Medicare NSC
TX00X903Medicare PIN