MEDICARE: HEART OF TEXAS FOOT CARE CENTER, P.A.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8K2280	OTHER	TX	BLUE CROSS & BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528061793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART OF TEXAS FOOT CARE CENTER, P.A.

Provider Business Mailing Address
First Line	:	103 A SOUTH PARK DR.
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801
Country	:	US
Telephone Number	:	326-646-0715
Fax Number	:	325-646-3734

Provider Business Practice Location Address
First Line	:	103 A SOUTH PARK DR.
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801
Country	:	US
Telephone Number	:	326-646-0715
Fax Number	:	325-646-3734

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	BOHN MARSHALL YOUNG
Credential	:	D.P.M.
Telephone Number	:	325-646-0715

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/06/2018

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Directions to “HEART OF TEXAS FOOT CARE CENTER, P.A. ” Practice Location

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