MEDICARE: ADVANTAGE FOOT CARE OF HOUSTON, PLLC

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	213EP1101X	Primary Podiatric Medicine Podiatrist	TX-2031	TX

General Provider Information

NPI Number	:	1639695406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE FOOT CARE OF HOUSTON, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 8411
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77288-8411
Country	:	US
Telephone Number	:	832-835-1442
Fax Number	:	832-369-1761

Provider Business Practice Location Address
First Line	:	8313 SOUTHWEST FWY STE 105
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1612
Country	:	US
Telephone Number	:	832-835-1442
Fax Number	:	832-369-1761

Authorized Official
Title or Position	:	RMA, ADMINISTRATION ASSISTANT
Name	:	KAY GREENBERG
Credential	:	RMA
Telephone Number	:	832-835-1442

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	03/17/2018

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