Provider Demographics
NPI:1629259346
Name:GEORGE C BAKATSAS
Entity Type:Organization
Organization Name:GEORGE C BAKATSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAKATSAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:832-768-6142
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-0098
Mailing Address - Country:US
Mailing Address - Phone:806-300-0134
Mailing Address - Fax:806-300-0851
Practice Address - Street 1:6849 82ND STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424
Practice Address - Country:US
Practice Address - Phone:806-300-0134
Practice Address - Fax:806-300-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1316213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092745101Medicaid
U54406Medicare UPIN
TX0077AWMedicare PIN