Provider Demographics
NPI:1679740401
Name:S & S FOOT SPECIALISTS, PA
Entity Type:Organization
Organization Name:S & S FOOT SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BABA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-297-8500
Mailing Address - Street 1:PO BOX 58508
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8508
Mailing Address - Country:US
Mailing Address - Phone:979-297-8500
Mailing Address - Fax:979-297-3027
Practice Address - Street 1:121 HIGHWAY 332 W STE G
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4099
Practice Address - Country:US
Practice Address - Phone:979-297-8500
Practice Address - Fax:979-297-3027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X, 213ES0103X
TXTX1036213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX480007330OtherMEDICARE RAILROAD
TXP00707603OtherMEDICARE RAILROAD
TX89480YOtherBCBS PROVIDER
TXF000DX906Medicaid
TXP00707603OtherMEDICARE RAILROAD
TX480007330OtherMEDICARE RAILROAD
TXF000DX906Medicaid
TX00DX90Medicare PIN
TXT16147Medicare UPIN