Provider Demographics
NPI:1992816912
Name:SOUTH AUSTIN FOOT ASSOCIATES PC
Entity type:Organization
Organization Name:SOUTH AUSTIN FOOT ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-447-2025
Mailing Address - Street 1:5656 BEE CAVES RD STE D204
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5236
Mailing Address - Country:US
Mailing Address - Phone:512-447-2025
Mailing Address - Fax:512-447-4968
Practice Address - Street 1:5656 BEE CAVES RD STE D204
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5236
Practice Address - Country:US
Practice Address - Phone:512-447-2025
Practice Address - Fax:512-447-4968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0823213E00000X
TX0709213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00DG46OtherMEDICARE GROUP
TX0821688-01Medicaid
TX1497805980OtherNPI- INDIVIDUAL
TX1083764419OtherNPI- INDIVIDUAL
TX85E256Medicare PIN
TXT16801Medicare UPIN
TX0192150001Medicare NSC
TX0821688-01Medicaid
00DG46OtherMEDICARE GROUP