1013090349 NPI number — SOUTH TEXAS FOOT SURGEONS, P.A.

Table of content: (NPI 1013090349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013090349 NPI number — SOUTH TEXAS FOOT SURGEONS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH TEXAS FOOT SURGEONS, P.A.
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:
1013090349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 690548
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78269-0548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-616-0819
Provider Business Mailing Address Fax Number:
210-692-9529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5282 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-4849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-616-0819
Provider Business Practice Location Address Fax Number:
210-692-9529
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FISH
Authorized Official First Name:
SHAY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-616-0819

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  1132 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 1132 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 156698601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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