Provider Demographics
NPI:1174606149
Name:WOODLY FOOT AND ANKLE SPECIALISTS PC
Entity type:Organization
Organization Name:WOODLY FOOT AND ANKLE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODLY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-284-8271
Mailing Address - Street 1:7208 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8693
Mailing Address - Country:US
Mailing Address - Phone:817-284-8271
Mailing Address - Fax:
Practice Address - Street 1:7208 GLENVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8693
Practice Address - Country:US
Practice Address - Phone:817-284-8271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1764213EP1101X, 213ES0103X, 213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1764OtherLICENSE
TX178674101Medicaid
TX198417101Medicaid
TX6307660001Medicare NSC
TX00X762Medicare PIN
TX00X666Medicare PIN
TX00X761Medicare PIN
TX8F5187Medicare PIN
TXV06193Medicare UPIN
TX8F5387Medicare PIN
TX8F5386Medicare PIN