Provider Demographics
NPI:1932236304
Name:ADVANCED FOOT& ANKLE FAMILY CLINIC, P.A
Entity Type:Organization
Organization Name:ADVANCED FOOT& ANKLE FAMILY CLINIC, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOUSSAINT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-251-1252
Mailing Address - Street 1:1024 LIFFEY DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5109
Mailing Address - Country:US
Mailing Address - Phone:512-251-8714
Mailing Address - Fax:
Practice Address - Street 1:1024 LIFFEY DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5109
Practice Address - Country:US
Practice Address - Phone:512-251-8714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1773213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0032QHOtherBLUE SHIELD
TX191667801Medicaid
TX612572OtherRAILROAD MEDICARE
TX612572OtherRAILROAD MEDICARE
TX00Y039Medicare PIN