Provider Demographics
NPI:1851565238
Name:JOHN G KNECHT, DPM PA
Entity Type:Organization
Organization Name:JOHN G KNECHT, DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-762-6433
Mailing Address - Street 1:1529 39TH STREET
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-6605
Mailing Address - Country:US
Mailing Address - Phone:409-762-6433
Mailing Address - Fax:409-762-8245
Practice Address - Street 1:1529 39TH ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-6605
Practice Address - Country:US
Practice Address - Phone:409-762-6433
Practice Address - Fax:409-762-8245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0451213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1566754-02Medicaid
TX121585701Medicaid
TX00R180Medicare PIN
TX1566754-02Medicaid
TX0295990001Medicare NSC