Healthcare Provider Details

I. General information

NPI: 1538194394
Provider Name (Legal Business Name): MCKINNEY PODIATRIC ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3692 E SAM HOUSTON PKWY S SUITE 100
PASADENA TX
77505-3137
US

IV. Provider business mailing address

3692 E SAM HOUSTON PKWY S SUITE 100
PASADENA TX
77505-3137
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1103
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 Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT W MCKINNEY
Title or Position: PRESIDENT
Credential: DPM
Phone: 713-946-1500