Healthcare Provider Details
I. General information
NPI: 1811564586
Provider Name (Legal Business Name): TXFAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/09/2021
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
16902 SOUTHWEST FWY STE 210
SUGAR LAND TX
77479-3574
US
IV. Provider business mailing address
24022 CINCO VILLAGE CENTER BLVD STE 240
KATY TX
77494-3393
US
V. Phone/Fax
- Phone: 832-376-8600
- Fax: 832-376-8686
- Phone: 832-376-8600
- Fax: 832-376-8686
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 332B00000X |
| Taxonomy | Durable Medical Equipment & Medical Supplies |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 213ES0103X |
| Taxonomy | Foot & Ankle Surgery Podiatrist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
PHILLIP
DAVID
APPLEGATE
JR.
Title or Position: PRESIDENT
Credential: DPM
Phone: 832-376-8600