Provider Demographics
NPI:1336356815
Name:FAMILY FOOT AND ANKLE CARE PLLC
Entity Type:Organization
Organization Name:FAMILY FOOT AND ANKLE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:806-747-4467
Mailing Address - Street 1:3702 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1320
Mailing Address - Country:US
Mailing Address - Phone:806-747-4467
Mailing Address - Fax:806-788-1708
Practice Address - Street 1:3702 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1320
Practice Address - Country:US
Practice Address - Phone:806-747-4467
Practice Address - Fax:806-788-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1827213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA48SCCTXMedicare ID - Type Unspecified
TX5983850001Medicare NSC
TX00Y172Medicare PIN