Healthcare Provider Details

I. General information

NPI: 1932227063
Provider Name (Legal Business Name): MCKINNEY PODIATRIC ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 WOODLAWN AVE STE 150B
PASADENA TX
77504-1922
US

IV. Provider business mailing address

4102 WOODLAWN AVE STE 140
PASADENA TX
77504-1948
US

V. Phone/Fax

Practice location:
  • Phone: 713-947-1016
  • Fax: 713-947-1071
Mailing address:
  • Phone: 713-946-1500
  • Fax: 713-946-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberL2281
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1172
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1444
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1645
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1832
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1103
License Number StateTX

VIII. Authorized Official

Name: SCOTT MCKINNEY
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 713-946-1500