Provider Demographics
NPI:1427328046
Name:AT HOME FOOT CARE PLLC
Entity type:Organization
Organization Name:AT HOME FOOT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MIRELES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:210-710-7547
Mailing Address - Street 1:14726 HIDDEN GLEN WOODS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1466
Mailing Address - Country:US
Mailing Address - Phone:210-852-2427
Mailing Address - Fax:210-598-7278
Practice Address - Street 1:1314 E SONTERRA BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4278
Practice Address - Country:US
Practice Address - Phone:210-852-2427
Practice Address - Fax:210-598-7278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB151518Medicare PIN