Provider Demographics
NPI:1356541346
Name:ACADEMY FOOT & ANKLE SPECIALISTS, P.A.
Entity type:Organization
Organization Name:ACADEMY FOOT & ANKLE SPECIALISTS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-424-3668
Mailing Address - Street 1:1940 E STATE HWY 114
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6526
Mailing Address - Country:US
Mailing Address - Phone:817-424-3668
Mailing Address - Fax:817-442-8637
Practice Address - Street 1:1940 HIGHWAY 114
Practice Address - Street 2:STE 150
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6526
Practice Address - Country:US
Practice Address - Phone:817-424-3668
Practice Address - Fax:817-442-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1364213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1356541346OtherGROUP NPI
TXU66467OtherDR. MARCIANO'S UPIN
TX1558321810OtherNPI PRIOVIDER
TXU66467OtherDR. MARCIANO'S UPIN
TX1356541346OtherGROUP NPI
TXU66467OtherDR. MARCIANO'S UPIN