Provider Demographics
NPI:1306993555
Name:ADVANCED PODIATRY GROUP, P. A.
Entity type:Organization
Organization Name:ADVANCED PODIATRY GROUP, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:TAKASHI
Authorized Official - Last Name:PIGNETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:281-292-7000
Mailing Address - Street 1:9303 PINECROFT DR
Mailing Address - Street 2:STE 100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3181
Mailing Address - Country:US
Mailing Address - Phone:281-292-7000
Mailing Address - Fax:281-292-5222
Practice Address - Street 1:9303 PINECROFT DR
Practice Address - Street 2:STE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3181
Practice Address - Country:US
Practice Address - Phone:281-292-7000
Practice Address - Fax:281-292-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1245213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U68QMedicare ID - Type Unspecified
TXU32678Medicare UPIN
TX4439390001Medicare NSC