Provider Demographics
NPI:1609918697
Name:FOOT & ANKLE PODIATRY OF TEXAS PC
Entity Type:Organization
Organization Name:FOOT & ANKLE PODIATRY OF TEXAS PC
Other - Org Name:F.A.S.T
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDFEARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-533-1622
Mailing Address - Street 1:601 SUNLAND PARK DR
Mailing Address - Street 2:BLDG 1
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5131
Mailing Address - Country:US
Mailing Address - Phone:915-533-1622
Mailing Address - Fax:915-533-1625
Practice Address - Street 1:601 SUNLAND PARK DR
Practice Address - Street 2:BLDG 1
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5131
Practice Address - Country:US
Practice Address - Phone:915-533-1622
Practice Address - Fax:915-533-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0458213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0060AZMedicare PIN
TX0902140001Medicare NSC