Provider Demographics
NPI:1851361679
Name:SPRING BRANCH PODIATRY LLP
Entity Type:Organization
Organization Name:SPRING BRANCH PODIATRY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-461-1010
Mailing Address - Street 1:9055 KATY FWY
Mailing Address - Street 2:#460
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1697
Mailing Address - Country:US
Mailing Address - Phone:713-461-1010
Mailing Address - Fax:713-973-7200
Practice Address - Street 1:9055 KATY FWY
Practice Address - Street 2:#460
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1697
Practice Address - Country:US
Practice Address - Phone:713-461-1010
Practice Address - Fax:713-973-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0460213ES0103X
TX1536213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143488804Medicaid
480033636OtherRR MEDICARE
7271253OtherAETNA
1457321713OtherNPI
TX176436701Medicaid
TX088310003Medicaid
1609846328OtherNPI
4103660OtherAETNA
480033637OtherRR MEDICARE
TX5420470001Medicare NSC
8F0347Medicare ID - Type Unspecified
TX176436701Medicaid
TX088310003Medicaid
8F0346Medicare ID - Type Unspecified
00979YMedicare ID - Type Unspecified