Healthcare Provider Details

I. General information

NPI: 1811318330
Provider Name (Legal Business Name): NORTH CENTRAL TEXAS FOOT & ANKLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 S FM 51 SUITE 103
DECATUR TX
76234-3642
US

IV. Provider business mailing address

1713 S FM 51 SUITE 103
DECATUR TX
76234-3642
US

V. Phone/Fax

Practice location:
  • Phone: 940-627-6976
  • Fax: 940-627-3491
Mailing address:
  • Phone: 940-627-6976
  • Fax: 940-627-3491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1932
License Number StateTX

VIII. Authorized Official

Name: RICKY CHILDERS
Title or Position: OFFICER
Credential:
Phone: 415-730-5058