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General NPI Number Information
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NPI Number | 1841594975
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Entity Type | Organization
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Legal Business Name | BELTWAY FOOT CLINIC PLLC
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 12234 SHADOW CREEK PKWY SUITE 1102
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City | PEARLAND
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State | TX
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Zip | 77584-7330
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Country | US
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Telephone | 713-340-3030
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Fax | 281-412-9961
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Provider Business Mailing Address
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Address Line | 9515 BELLAIRE BLVD #B
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City | HOUSTON
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State | TX
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Zip | 77036-4546
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Country | US
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Telephone | 713-340-3030
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Fax | 281-412-9961
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAUREN L SUM
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Credential | DPM
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Telephone | 713-340-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1729
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License Number State | TX
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