Provider Demographics
NPI:1215091582
Name:MCKINNEY PODIATRIC ASSOCIATES PA
Entity type:Organization
Organization Name:MCKINNEY PODIATRIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-946-1500
Mailing Address - Street 1:3692 E SAM HOUSTON PKWY S STE 100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3136
Mailing Address - Country:US
Mailing Address - Phone:713-946-1500
Mailing Address - Fax:713-946-0200
Practice Address - Street 1:3722 N MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3304
Practice Address - Country:US
Practice Address - Phone:281-837-1500
Practice Address - Fax:281-837-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1103213ES0131X
TX1172213ES0131X
TX1444213ES0131X
TX1645213ES0131X
TX1832213ES0131X
213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084070401Medicaid
TX084070401Medicaid
TX5056520003Medicare NSC