Provider Demographics
NPI:1174952600
Name:EAST TEXAS HAPPY FEET FOOT CLINIC PC
Entity type:Organization
Organization Name:EAST TEXAS HAPPY FEET FOOT CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:903-399-5506
Mailing Address - Street 1:305 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6518
Mailing Address - Country:US
Mailing Address - Phone:903-399-5506
Mailing Address - Fax:
Practice Address - Street 1:305 N 5TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6518
Practice Address - Country:US
Practice Address - Phone:903-399-5506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty