Provider Demographics
NPI:1922579267
Name:PMC FOOT AND ANKLE CLINIC PA
Entity type:Organization
Organization Name:PMC FOOT AND ANKLE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:832-585-1620
Mailing Address - Street 1:128 VISION PARK BLVD STE 135
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3017
Mailing Address - Country:US
Mailing Address - Phone:832-585-1620
Mailing Address - Fax:855-787-3211
Practice Address - Street 1:128 VISION PARK BLVD STE 135
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3017
Practice Address - Country:US
Practice Address - Phone:832-585-1620
Practice Address - Fax:855-787-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Multi-Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Multi-Specialty