Provider Demographics
NPI:1598296592
Name:LEDGER FOOT AND ANKLE CLINIC
Entity Type:Organization
Organization Name:LEDGER FOOT AND ANKLE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-519-3668
Mailing Address - Street 1:800 W CENTRAL TEXAS EXPY STE 155
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1995
Mailing Address - Country:US
Mailing Address - Phone:254-519-3668
Mailing Address - Fax:254-501-3668
Practice Address - Street 1:800 W CENTRAL TEXAS EXPY STE 155
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1995
Practice Address - Country:US
Practice Address - Phone:254-519-3668
Practice Address - Fax:254-501-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1582213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid
TX=========Medicaid