Provider Demographics
NPI:1942789995
Name:TEXAN FOOT CARE CLINIC, PLLC
Entity Type:Organization
Organization Name:TEXAN FOOT CARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YERMESHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:832-244-0373
Mailing Address - Street 1:1315 ST JOSEPH PKWY STE 301
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8229
Mailing Address - Country:US
Mailing Address - Phone:346-204-5528
Mailing Address - Fax:
Practice Address - Street 1:1315 ST JOSEPH PKWY STE 301
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8229
Practice Address - Country:US
Practice Address - Phone:346-204-5528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2269213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX374359301Medicaid