Provider Demographics
NPI:1679645196
Name:FOOT AND ANKLE TREATMENT CENTER OF SAN ANTONIO
Entity Type:Organization
Organization Name:FOOT AND ANKLE TREATMENT CENTER OF SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:RUTSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:210-477-3668
Mailing Address - Street 1:10114 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1319
Mailing Address - Country:US
Mailing Address - Phone:210-477-3668
Mailing Address - Fax:210-558-0868
Practice Address - Street 1:10114 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1319
Practice Address - Country:US
Practice Address - Phone:210-477-3668
Practice Address - Fax:210-558-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1642213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDF8496OtherRAILROAD MEDICARE
TX00X483Medicare PIN
TX5834730001Medicare NSC