Provider Demographics
NPI:1831147990
Name:PODIATRY CONSULTANTS OF TEXAS, INC
Entity type:Organization
Organization Name:PODIATRY CONSULTANTS OF TEXAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:866-950-3627
Mailing Address - Street 1:1450 W GRAND PKWY S
Mailing Address - Street 2:G-240
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8300
Mailing Address - Country:US
Mailing Address - Phone:866-950-3627
Mailing Address - Fax:800-652-8206
Practice Address - Street 1:1331 W GRAND PKWY N
Practice Address - Street 2:STE 145
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2717
Practice Address - Country:US
Practice Address - Phone:866-950-3627
Practice Address - Fax:800-652-8206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182737003Medicaid
TXDF4589OtherRAIL RD. MEDICARE
TX182737003Medicaid
TX00W989Medicare PIN
TXDF4589OtherRAIL RD. MEDICARE
TX00W992Medicare PIN
TX00W994Medicare PIN
TX00W990Medicare PIN
TX182737003Medicaid
TX5663880001Medicare NSC