1629682919 NPI number — CENTRAL TEXAS ORTHOPAEDIC FOOT AND ANKLE CENTER, PLLC

Table of content: NICHOLAS JOHN LACO DPM (NPI 1134618705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629682919 NPI number — CENTRAL TEXAS ORTHOPAEDIC FOOT AND ANKLE CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL TEXAS ORTHOPAEDIC FOOT AND ANKLE CENTER, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629682919
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5100 FRANKLIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76710-6922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-202-8115
Provider Business Mailing Address Fax Number:
254-522-7964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76710-6922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-313-9559
Provider Business Practice Location Address Fax Number:
254-522-7964
Provider Enumeration Date:
09/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BEDNARZ
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
336-202-8115

Provider Taxonomy Codes

  • Taxonomy code: 207XX0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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