Provider Demographics
NPI:1174538623
Name:PODIATRY OF CENTRAL TEXAS PA
Entity type:Organization
Organization Name:PODIATRY OF CENTRAL TEXAS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BATTLES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:800-957-9971
Mailing Address - Street 1:PO BOX 496
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:TX
Mailing Address - Zip Code:76648-0496
Mailing Address - Country:US
Mailing Address - Phone:800-957-9971
Mailing Address - Fax:888-878-2856
Practice Address - Street 1:701 MCCLINTIC DR
Practice Address - Street 2:
Practice Address - City:GROESBECK
Practice Address - State:TX
Practice Address - Zip Code:76642-2128
Practice Address - Country:US
Practice Address - Phone:800-957-9971
Practice Address - Fax:888-878-2856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1771213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0026NVOtherBCBS
TX188679801Medicaid
TX194386201Medicaid
TX194386202Medicaid
TX00X223Medicare PIN
TX194386201Medicaid