Provider Demographics
NPI: | 1770032898 |
---|---|
Name: | HAYS FOOT AND ANKLE SURGICAL ASSOCIATES, PLLC |
Entity Type: | Organization |
Organization Name: | HAYS FOOT AND ANKLE SURGICAL ASSOCIATES, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/DPM |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JEFF |
Authorized Official - Middle Name: | SPOEDE |
Authorized Official - Last Name: | HENKE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPM |
Authorized Official - Phone: | 512-268-3668 |
Mailing Address - Street 1: | 135 BUNTON CREEK RD STE 300 |
Mailing Address - Street 2: | |
Mailing Address - City: | KYLE |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78640-5701 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 512-268-3668 |
Mailing Address - Fax: | 512-268-5785 |
Practice Address - Street 1: | 135 BUNTON CREEK RD STE 300 |
Practice Address - Street 2: | |
Practice Address - City: | KYLE |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78640-5701 |
Practice Address - Country: | US |
Practice Address - Phone: | 512-268-3668 |
Practice Address - Fax: | 512-268-5785 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-09-30 |
Last Update Date: | 2022-04-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207Q00000X, 207QS0010X, 207R00000X, 207RS0010X, 207XX0004X, 2085R0202X, 2085R0204X, 2085U0001X, 2086S0129X, 208D00000X, 213E00000X, 213ER0200X, 213ES0103X, 225100000X | ||
TX | 1769 | 213ES0103X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Single Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RS0010X | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | Group - Multi-Specialty |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Multi-Specialty |
No | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | Group - Multi-Specialty |
No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 213ER0200X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Radiology | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 364761201 | Medicaid | |
TX | 364761201 | Medicaid |