Provider Demographics
NPI:1306965827
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:MR
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 1:4102 WOODLAWN AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1948
Mailing Address - Country:US
Mailing Address - Phone:713-946-1500
Mailing Address - Fax:713-946-0200
Practice Address - Street 1:910 S WAYSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3417
Practice Address - Country:US
Practice Address - Phone:713-921-3232
Practice Address - Fax:713-921-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL22812084N0400X
TX1172213ES0131X
TX1444213ES0131X
TX1645213ES0131X
TX1832213ES0131X
TX1103213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084070401Medicaid
TX084070401Medicaid
TX5056520007Medicare NSC