=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265574602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABILENE FOOTCARE ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 03/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 AMBLER AVE SUITE 102
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79601-2216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-670-3338
-----------------------------------------------------
Fax | 325-670-4078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 AMBLER AVE SUITE 102
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79601-2216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-670-3338
-----------------------------------------------------
Fax | 325-670-4078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INSURANCE CLERK
-----------------------------------------------------
Name | MRS. ANNIE SMALLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 325-670-3338
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 0778 0904
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------