Provider Demographics
NPI:1174913065
Name:DIAGNOSTIC FOOT SPECALISTS
Entity type:Organization
Organization Name:DIAGNOSTIC FOOT SPECALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAASE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-862-3338
Mailing Address - Street 1:1740 W 27TH ST
Mailing Address - Street 2:#110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1440
Mailing Address - Country:US
Mailing Address - Phone:713-862-3338
Mailing Address - Fax:713-862-8328
Practice Address - Street 1:9319 PINECROFT DR
Practice Address - Street 2:#120
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3484
Practice Address - Country:US
Practice Address - Phone:713-862-3338
Practice Address - Fax:713-862-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1746213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T49ROtherMEDICARE GROUP ID#