Provider Demographics
NPI:1740769819
Name:SOUTHWEST AUSTIN FOOT & ANKLE CLINIC, PLLC
Entity type:Organization
Organization Name:SOUTHWEST AUSTIN FOOT & ANKLE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:WHITESIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-789-1190
Mailing Address - Street 1:5625 EIGER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8978
Mailing Address - Country:US
Mailing Address - Phone:512-447-4122
Mailing Address - Fax:512-727-0505
Practice Address - Street 1:5625 EIGER RD STE 110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8978
Practice Address - Country:US
Practice Address - Phone:512-447-4122
Practice Address - Fax:512-727-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty