1689214546 NPI number — HEMESATH PODIATRY PLLC

Table of content: (NPI 1689214546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689214546 NPI number — HEMESATH PODIATRY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEMESATH PODIATRY 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:
1689214546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 976
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76234-0976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-538-9002
Provider Business Mailing Address Fax Number:
855-374-3284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 S ARCHER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENRIETTA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76365-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-538-9002
Provider Business Practice Location Address Fax Number:
855-374-3284
Provider Enumeration Date:
01/08/2020

Additional Information

Authorized Official

Authorized Official Last Name:
HEMESATH
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER/DPM
Authorized Official Telephone Number:
940-538-9002

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 903363 . This is a "MEDICARE PTAN GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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