Provider Demographics
NPI:1063522993
Name:THE PODIATRY GROUP OF SOUTH TEXAS, PA
Entity type:Organization
Organization Name:THE PODIATRY GROUP OF SOUTH TEXAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-227-8700
Mailing Address - Street 1:5825 CALLAGHAN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1106
Mailing Address - Country:US
Mailing Address - Phone:210-227-8700
Mailing Address - Fax:210-348-9130
Practice Address - Street 1:5825 CALLAGHAN RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1106
Practice Address - Country:US
Practice Address - Phone:210-227-8700
Practice Address - Fax:210-348-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157841101Medicaid
TX157841122Medicaid
TX49886670017OtherPTAN
TX00817UOtherBCBS
TX4986670017Medicare NSC
TX4986670019Medicare NSC
TX4986670002Medicare NSC
TX4986670013Medicare NSC
TX4986670015Medicare NSC
TX4986670022Medicare NSC
TX4986670020Medicare NSC
TX4986670021Medicare NSC
TX00817UOtherBCBS
TX157841101Medicaid
TX4986670004Medicare NSC
TX4986670010Medicare NSC
TX4986670012Medicare NSC
TX4986670016Medicare NSC
TX4986670018Medicare NSC
TX4986670011Medicare NSC
TX4986670001Medicare NSC
TX4986670024Medicare NSC
TX49886670017OtherPTAN
TX4986670014Medicare NSC
TX4986670042Medicare NSC
TX00817UMedicare PIN