Provider Demographics
NPI:1710181011
Name:GULF COAST FOOT CLINIC PA
Entity Type:Organization
Organization Name:GULF COAST FOOT CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:361-552-0295
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-0125
Mailing Address - Country:US
Mailing Address - Phone:361-552-0295
Mailing Address - Fax:866-813-3644
Practice Address - Street 1:815 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-3025
Practice Address - Country:US
Practice Address - Phone:361-552-0295
Practice Address - Fax:361-582-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1296213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018809601Medicaid
TX0036QPOtherBLUE CROSS
TX018809601OtherSUPERIOR
TX480019673OtherMEDICARE RRB
TX00R96MMedicare PIN
TX018809601Medicaid