MEDICARE: COMPASSIONATE FOOT CARE CLINIC, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	1848	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0083SG	OTHER	TX	BLUE CROSS BLUE SHIELD OF TX
2	8536466	OTHER	TX	CIGNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033367669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE FOOT CARE CLINIC, PA

Provider Business Mailing Address
First Line	:	2776 BAY SHORE LN
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-7255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2776 BAY SHORE LN
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-7255
Country	:	US
Telephone Number	:	817-948-3576
Fax Number	:

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. JAMELIA ABRAMS
Credential	:	DPM
Telephone Number	:	817-948-3576

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	06/12/2012

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