# BRAZOS VALLEY FOOT CARE PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194280370
- **Authorized official:** GINA L PARKER (BILLING MANAGER)
- **Authorized official phone:** (979) 776-6060

## Contact information

- **Practice address:** 3312 LONGMIRE DR, COLLEGE STATION, TX 77845-5812
- **Practice address phone:** (979) 776-6060
- **Practice address fax:** (979) 776-6172
- **Mailing address:** 3312 LONGMIRE DR, COLLEGE STATION, TX 77845-5812
- **Mailing address phone:** (979) 776-6060
- **Mailing address fax:** (979) 776-6172

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | — |

## Other

- **Enumeration date:** 02/01/2019
- **Last updated:** 02/01/2019