Provider Demographics
NPI:1013090349
Name:SOUTH TEXAS FOOT SURGEONS, P.A.
Entity Type:Organization
Organization Name:SOUTH TEXAS FOOT SURGEONS, P.A.
Other - Org Name:PROGRESSIVE PODIATRY CENTERS, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:210-616-0819
Mailing Address - Street 1:PO BOX 690548
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78269-0548
Mailing Address - Country:US
Mailing Address - Phone:210-616-0819
Mailing Address - Fax:210-692-9529
Practice Address - Street 1:5282 MEDICAL DR
Practice Address - Street 2:SUITE 260
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4849
Practice Address - Country:US
Practice Address - Phone:210-616-0819
Practice Address - Fax:210-692-9529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156698601Medicaid