Provider Demographics
NPI:1750464251
Name:AUSTIN FOOT CENTER PROFESSIONAL COPORATION
Entity Type:Organization
Organization Name:AUSTIN FOOT CENTER PROFESSIONAL COPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CASANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-327-9251
Mailing Address - Street 1:5656 BEE W CAVES RD
Mailing Address - Street 2:#D204
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5236
Mailing Address - Country:US
Mailing Address - Phone:512-327-9251
Mailing Address - Fax:512-327-9742
Practice Address - Street 1:5656 W BEE CAVES RD
Practice Address - Street 2:#D204
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5236
Practice Address - Country:US
Practice Address - Phone:512-327-9251
Practice Address - Fax:512-327-9742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547213E00000X
TX575213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1120040001Medicare NSC
TX1750464251Medicare PIN