Provider Demographics
NPI:1912977729
Name:FEET FIRST PODIATRIC CARE PA
Entity type:Organization
Organization Name:FEET FIRST PODIATRIC CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:FREDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:210-431-9060
Mailing Address - Street 1:PO BOX 270504
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75027-0504
Mailing Address - Country:US
Mailing Address - Phone:972-874-0116
Mailing Address - Fax:972-874-0206
Practice Address - Street 1:422 N GENERAL MCMULLEN
Practice Address - Street 2:STE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-1572
Practice Address - Country:US
Practice Address - Phone:210-431-9060
Practice Address - Fax:210-431-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000664N2Medicaid
5198710001Medicare NSC
5613680001Medicare NSC
TXZ000664N2Medicaid