Provider Demographics
NPI:1366559981
Name:ADDISON FOOT CENTER
Entity type:Organization
Organization Name:ADDISON FOOT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-239-4398
Mailing Address - Street 1:5000 BELTLINE RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254
Mailing Address - Country:US
Mailing Address - Phone:972-239-4398
Mailing Address - Fax:972-239-4329
Practice Address - Street 1:5000 BELT LINE RD
Practice Address - Street 2:SUITE 900
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-6789
Practice Address - Country:US
Practice Address - Phone:972-239-4398
Practice Address - Fax:972-239-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0562213E00000X
TX0588213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX886223OtherBLUE CROSS BLUE SHIELD
TX1124299672OtherNPI
TX1760492839OtherNPI
TX886222OtherBLUE CROSS BLUE SHIELD
TX00PM29Medicare PIN
TX886222OtherBLUE CROSS BLUE SHIELD
TXT16788Medicare UPIN
TX0471200001Medicare NSC