Provider Demographics
NPI:1619241437
Name:FOOT CENTER MCALLEN-WESLACO PLLC
Entity Type:Organization
Organization Name:FOOT CENTER MCALLEN-WESLACO PLLC
Other - Org Name:FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:956-682-4187
Mailing Address - Street 1:4103 N JACKSON ROAD
Mailing Address - Street 2:STE. 200
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:956-682-4187
Mailing Address - Fax:956-682-9739
Practice Address - Street 1:4103 N JACKSON ROAD
Practice Address - Street 2:STE. 200
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:956-682-4187
Practice Address - Fax:956-682-9739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX319914301Medicaid
TX6793710001Medicare NSC
TX272036YNSEMedicare PIN
TX269162YNSEMedicare PIN
TX269102YNSEMedicare PIN
TX319914301Medicaid