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General NPI Number Information
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NPI Number | 1699382879
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Entity Type | Organization
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Legal Business Name | ROANOKE FOOT & ANKLE INSTITUTE, PLLC
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 1713 S FM 51 STE 103
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City | DECATUR
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State | TX
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Zip | 76234-3644
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Country | US
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Telephone | 940-627-0993
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Fax |
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Provider Business Mailing Address
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Address Line | 1224 N HIGHWAY 377 # 303-151
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City | ROANOKE
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State | TX
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Zip | 76262-9103
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Country | US
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Telephone | 817-674-7494
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SAMANTHA CHILDERS
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Credential | DPM
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Telephone | 415-602-2048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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