Provider Demographics
NPI:1982673455
Name:CENTER FOR FOOT AND ANKLE SURGERY, PA
Entity Type:Organization
Organization Name:CENTER FOR FOOT AND ANKLE SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-477-8853
Mailing Address - Street 1:P.O. BOX 4948
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-4948
Mailing Address - Country:US
Mailing Address - Phone:512-477-8853
Mailing Address - Fax:512-477-2592
Practice Address - Street 1:1015 E 32ND ST
Practice Address - Street 2:STE 204
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2707
Practice Address - Country:US
Practice Address - Phone:512-477-8853
Practice Address - Fax:512-477-2592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1625261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0093JQOtherBCBS OF TEXAS
TX158149801Medicaid
TX158149801Medicaid
TXU95320Medicare UPIN
TX0093JQOtherBCBS OF TEXAS