Provider Demographics
NPI:1689834376
Name:HILL COUNTRY ADVANCED FOOT AND ANKLE CENTER, P.A.
Entity Type:Organization
Organization Name:HILL COUNTRY ADVANCED FOOT AND ANKLE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-693-8144
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-0220
Mailing Address - Country:US
Mailing Address - Phone:830-693-8144
Mailing Address - Fax:
Practice Address - Street 1:200 COUNTY ROAD 340A
Practice Address - Street 2:4
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-4537
Practice Address - Country:US
Practice Address - Phone:830-693-8144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HILL COUNTRY ADVANCED FOOT AND ANKLE CENTER, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1783805-01Medicaid
TX00710ZOtherGROUP NUMBER
TX00710ZOtherGROUP NUMBER