Provider Demographics
NPI:1841594975
Name:BELTWAY FOOT CLINIC PLLC
Entity Type:Organization
Organization Name:BELTWAY FOOT CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-340-3030
Mailing Address - Street 1:9515 BELLAIRE BLVD
Mailing Address - Street 2:#B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4546
Mailing Address - Country:US
Mailing Address - Phone:713-340-3030
Mailing Address - Fax:281-412-9961
Practice Address - Street 1:12234 SHADOW CREEK PKWY
Practice Address - Street 2:SUITE 1102
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7330
Practice Address - Country:US
Practice Address - Phone:713-340-3030
Practice Address - Fax:281-412-9961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1729213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty