Provider Demographics
NPI:1972641975
Name:RICHARD M ADAMS DPM PA
Entity type:Organization
Organization Name:RICHARD M ADAMS DPM PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-573-7178
Mailing Address - Street 1:1008 PALUXY RD
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2397
Mailing Address - Country:US
Mailing Address - Phone:817-573-7178
Mailing Address - Fax:817-573-7471
Practice Address - Street 1:1008 PALUXY RD
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2397
Practice Address - Country:US
Practice Address - Phone:817-573-7178
Practice Address - Fax:817-573-7471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1008213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0079QDOtherBCBS
DF4972OtherRR MEDICARE
TX8F4274Medicare PIN
DF4972OtherRR MEDICARE
T11871Medicare UPIN
TX00X197Medicare ID - Type UnspecifiedGROUP NUMBER FOR MEDICARE