MEDICARE: MCKINNEY PODIATRIC ASSOCIATES 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	2084N0400X	Neurology Physician	L2281	TX
2	213ES0131X	Foot Surgery Podiatrist	1172	TX
3	213ES0131X	Foot Surgery Podiatrist	1444	TX
4	213ES0131X	Foot Surgery Podiatrist	1645	TX
5	213ES0131X	Foot Surgery Podiatrist	1832	TX
6	213ES0131X	Foot Surgery Podiatrist	1103	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306965827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCKINNEY PODIATRIC ASSOCIATES PA

Provider Business Mailing Address
First Line	:	4102 WOODLAWN AVE STE 140
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1948
Country	:	US
Telephone Number	:	713-946-1500
Fax Number	:	713-946-0200

Provider Business Practice Location Address
First Line	:	910 S WAYSIDE DR STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-3417
Country	:	US
Telephone Number	:	713-921-3232
Fax Number	:	713-921-4466

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SCOTT W MCKINNEY
Credential	:	D.P.M.
Telephone Number	:	713-946-1500

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	10/25/2010

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Directions to “MCKINNEY PODIATRIC ASSOCIATES PA ” Practice Location

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