Provider Demographics
NPI:1699944348
Name:NEW BRAUNFELS PODIATRY ASSOCIATES, LLC
Entity type:Organization
Organization Name:NEW BRAUNFELS PODIATRY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-625-1484
Mailing Address - Street 1:1524 N WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6074
Mailing Address - Country:US
Mailing Address - Phone:830-625-1642
Mailing Address - Fax:830-625-1672
Practice Address - Street 1:1524 N WALNUT AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6074
Practice Address - Country:US
Practice Address - Phone:830-625-1642
Practice Address - Fax:830-625-1672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00T41EOtherGROUP NUMBER
TX0852469-01Medicaid
TX0852469-01Medicaid