Provider Demographics
NPI:1790813541
Name:ATHENS FOOT AND ANKLE HEALTH AND SURGERY, PC
Entity Type:Organization
Organization Name:ATHENS FOOT AND ANKLE HEALTH AND SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:903-675-1337
Mailing Address - Street 1:1123 S PALESTINE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3646
Mailing Address - Country:US
Mailing Address - Phone:903-675-1337
Mailing Address - Fax:903-675-4351
Practice Address - Street 1:1123 S PALESTINE STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3646
Practice Address - Country:US
Practice Address - Phone:903-675-1337
Practice Address - Fax:903-675-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1533P213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0067GROtherBCBS PROVIDER NUMBER
TX1013957232OtherTYPE I NPI
TX5370860001Medicare NSC
TX0067GROtherBCBS PROVIDER NUMBER
TX00230PMedicare PIN