Healthcare Provider Details

I. General information

NPI: 1982673455
Provider Name (Legal Business Name): CENTER FOR FOOT AND ANKLE SURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E 32ND ST STE 204
AUSTIN TX
78705-2707
US

IV. Provider business mailing address

P.O. BOX 4948
AUSTIN TX
78765-4948
US

V. Phone/Fax

Practice location:
  • Phone: 512-477-8853
  • Fax: 512-477-2592
Mailing address:
  • Phone: 512-477-8853
  • Fax: 512-477-2592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number1625
License Number StateTX

VIII. Authorized Official

Name: CHARLES JASON HUBBARD
Title or Position: OWNER
Credential: D.P.M.
Phone: 512-477-8853