Provider Demographics
NPI:1528061793
Name:HEART OF TEXAS FOOT CARE CENTER, P.A.
Entity type:Organization
Organization Name:HEART OF TEXAS FOOT CARE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BOHN
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:325-646-0715
Mailing Address - Street 1:103 A SOUTH PARK DR.
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801
Mailing Address - Country:US
Mailing Address - Phone:326-646-0715
Mailing Address - Fax:325-646-3734
Practice Address - Street 1:103 A SOUTH PARK DR.
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801
Practice Address - Country:US
Practice Address - Phone:326-646-0715
Practice Address - Fax:325-646-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X
TX1453213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K2280OtherBLUE CROSS & BLUE SHIELD
TX092724604Medicaid
TX159094503Medicaid
TX1638975Medicaid
TXU74300Medicare UPIN
TX00296VMedicare ID - Type Unspecified
TX092724604Medicaid
TX4872810001Medicare NSC