Healthcare Provider Details

I. General information

NPI: 1720464837
Provider Name (Legal Business Name): HOUSTON ADVANCED & MINIMALLY INVASIVE LOWER EXTREMITY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 SOUTHWEST FWY
HOUSTON TX
77074-1802
US

IV. Provider business mailing address

PO BOX 674074
DALLAS TX
75267-4074
US

V. Phone/Fax

Practice location:
  • Phone: 214-396-3936
  • Fax: 214-378-4664
Mailing address:
  • Phone: 214-396-3936
  • Fax: 214-378-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1576
License Number StateTX

VIII. Authorized Official

Name: MISS BRANDY KAY BARROW
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 214-396-3936