Provider Demographics
NPI:1124804034
Name:PODIATRY CLINICS OF TEXAS
Entity type:Organization
Organization Name:PODIATRY CLINICS OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SILAS
Authorized Official - Middle Name:ODANGA
Authorized Official - Last Name:SALANO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-939-2446
Mailing Address - Street 1:4202 SPRING LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5861
Mailing Address - Country:US
Mailing Address - Phone:817-800-8380
Mailing Address - Fax:
Practice Address - Street 1:8 MEDICAL PKWY STE 202
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7842
Practice Address - Country:US
Practice Address - Phone:817-800-8380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty