Provider Demographics
NPI:1922286988
Name:ELIZABETH A KROBOTH, DPM, PA
Entity Type:Organization
Organization Name:ELIZABETH A KROBOTH, DPM, PA
Other - Org Name:SOUTH SHORE PODIATRY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAVOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-535-3800
Mailing Address - Street 1:350 N TEXAS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4959
Mailing Address - Country:US
Mailing Address - Phone:281-535-3800
Mailing Address - Fax:281-535-3805
Practice Address - Street 1:350 N TEXAS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4959
Practice Address - Country:US
Practice Address - Phone:281-535-3800
Practice Address - Fax:281-535-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1227213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164791901Medicaid
TX0060KMOtherBLUE CROSS BLUE SHIELD
TX0060KMOtherBLUE CROSS BLUE SHIELD
TXU42367Medicare UPIN
TX164791901Medicaid