MEDICARE: PODIATRY CONSULTANTS OF TEXAS, INC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DF4589	OTHER	TX	RAIL RD. MEDICARE

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	:	1831147990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PODIATRY CONSULTANTS OF TEXAS, INC

Provider Business Mailing Address
First Line	:	1450 W GRAND PKWY S
Second Line	:	G-240
City	:	KATY
State	:	TX
Zip	:	77494-8300
Country	:	US
Telephone Number	:	866-950-3627
Fax Number	:	800-652-8206

Provider Business Practice Location Address
First Line	:	1331 W GRAND PKWY N
Second Line	:	STE 145
City	:	KATY
State	:	TX
Zip	:	77493-2717
Country	:	US
Telephone Number	:	866-950-3627
Fax Number	:	800-652-8206

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JAMES M. JACOBS
Credential	:	DPM
Telephone Number	:	866-950-3627

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	10/05/2012

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