ADVANCED FOOT AND ANKLE ASSOCIATES PLLC; NPI #1568783553

Contact Information

ADVANCED FOOT AND ANKLE ASSOCIATES PLLC

6312 AZLE AVE
LAKE WORTH, TX 76135-2442

Phone: 817-238-8400
Fax: 817-238-8401
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Surgery, Foot & Ankle	213ES0103X	48	Podiatry

Indicates primary specialty

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NPI Profile & details for ADVANCED FOOT AND ANKLE ASSOCIATES PLLC

NPI Number 1568783553

LBN Legal business name ADVANCED FOOT AND ANKLE ASSOCIATES PLLC

Authorized official RUSSELL PENDLETON - (OWNER/PHYSICIAN)

Entity Organization

Organization subpart ¹ No

Enumeration date 06/14/2010

Last updated 11/28/2023 - About 3 years ago

Identifiers

TX	License #	1916
TX	Medicaid	218408702
TX	Medicaid	218408703
TX	Other	0029WA	BCBS TX

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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