MEDICARE: ACCESS PODIATRY CENTER, LLC

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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1225688583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS PODIATRY CENTER, LLC

Provider Business Mailing Address
First Line	:	402 E ZAVALA ST STE 3
Second Line	:
City	:	CRYSTAL CITY
State	:	TX
Zip	:	78839-3337
Country	:	US
Telephone Number	:	830-448-5188
Fax Number	:	830-768-9248

Provider Business Practice Location Address
First Line	:	402 E ZAVALA ST STE 3
Second Line	:
City	:	CRYSTAL CITY
State	:	TX
Zip	:	78839-3337
Country	:	US
Telephone Number	:	830-448-5188
Fax Number	:	830-768-9248

Authorized Official
Title or Position	:	PODIATRIST
Name	:	MR. MICHAEL W CANNON
Credential	:	D.P.M.
Telephone Number	:	830-448-5188

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	09/24/2025

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