MEDICARE: CODWELL FAMILY FOOT CENTER, 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	332B00000X	Durable Medical Equipment & Medical Supplies	4876770001	TX
2	213ES0103X	Foot & Ankle Surgery Podiatrist	1279	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	:	1497937759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CODWELL FAMILY FOOT CENTER, PA

Provider Business Mailing Address
First Line	:	6655 TRAVIS ST STE 840
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1342
Country	:	US
Telephone Number	:	713-526-0600
Fax Number	:	713-526-7121

Provider Business Practice Location Address
First Line	:	6655 TRAVIS ST STE 840
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1342
Country	:	US
Telephone Number	:	713-526-0600
Fax Number	:	713-526-7121

Authorized Official
Title or Position	:	OWNER/PRESIDENT/MEDICAL DIRECTOR
Name	:	DR. JOHN ELIHUE CODWELL
Credential	:	DPM
Telephone Number	:	713-526-0600

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	03/09/2022

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