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General NPI Number Information
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NPI Number | 1942011986
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Entity Type | Organization
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Legal Business Name | FAS OF TW LLC
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 9191 PINECROFT DR STE 100
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City | SHENANDOAH
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State | TX
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Zip | 77380-2797
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Country | US
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Telephone | 346-590-2730
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Fax |
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Provider Business Mailing Address
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Address Line | 434 W ASCENSION WAY STE 425
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City | MURRAY
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State | UT
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Zip | 84123-3102
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Country | US
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Telephone | 801-292-4425
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MARCIN NOBLE VACLAW
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Credential | DPM
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Telephone | 281-909-7722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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