1356541346 NPI number — ACADEMY FOOT & ANKLE SPECIALISTS, P.A.

Table of content: (NPI 1356541346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356541346 NPI number — ACADEMY FOOT & ANKLE SPECIALISTS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACADEMY FOOT & ANKLE SPECIALISTS, 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:
1356541346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1940 E STATE HWY 114
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
SOUTHLAKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76092-6526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-424-3668
Provider Business Mailing Address Fax Number:
817-442-8637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1940 HIGHWAY 114
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-6526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-424-3668
Provider Business Practice Location Address Fax Number:
817-442-8637
Provider Enumeration Date:
07/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NUNEZ
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
817-424-3668

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  1364 , 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: 1356541346 . This is a "GROUP NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: U66467 . This is a "DR. MARCIANO'S UPIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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