Provider Demographics
NPI:1962517680
Name:CENTERS FOR ADVANCED FOOT CARE
Entity type:Organization
Organization Name:CENTERS FOR ADVANCED FOOT CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:281-531-4100
Mailing Address - Street 1:12121 RICHMOND AVE
Mailing Address - Street 2:SUITE 415
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2432
Mailing Address - Country:US
Mailing Address - Phone:281-531-4100
Mailing Address - Fax:281-531-9600
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:SUITE 415
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2432
Practice Address - Country:US
Practice Address - Phone:281-531-4100
Practice Address - Fax:281-531-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0850213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0031AKOtherBC
TX080358701Medicaid
TX116196003Medicaid
DF6905OtherRR MEDICARE
TX135217102Medicaid
TXU65757Medicare UPIN
0023BDMedicare PIN
0087BDMedicare PIN
0031AKOtherBC