Provider Demographics
NPI:1699172890
Name:ADVANCED DIAGNOSTIC FOOT & ANKLE SPECIALISTS OF CY-FAIR
Entity type:Organization
Organization Name:ADVANCED DIAGNOSTIC FOOT & ANKLE SPECIALISTS OF CY-FAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-463-7208
Mailing Address - Street 1:9405 HUFFMEISTER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2891
Mailing Address - Country:US
Mailing Address - Phone:281-463-7208
Mailing Address - Fax:
Practice Address - Street 1:9405 HUFFMEISTER RD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2891
Practice Address - Country:US
Practice Address - Phone:281-463-7208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0644302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OA5661Medicare UPIN