Provider Demographics
NPI:1316122609
Name:PODIATRY SPECIALISTS PA
Entity type:Organization
Organization Name:PODIATRY SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEX
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:281-859-6100
Mailing Address - Street 1:16100 CAIRNWAY DR STE 250
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3500
Mailing Address - Country:US
Mailing Address - Phone:281-859-6100
Mailing Address - Fax:
Practice Address - Street 1:9180 KATY FWY STE 202
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7443
Practice Address - Country:US
Practice Address - Phone:713-647-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXASC234261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical