Organization
BRAZOS VALLEY FOOT CARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA L PARKER (BILLING MANAGER)
(979) 776-6060
Entity
Organization
Contact information
Practice address
3312 LONGMIRE DR, COLLEGE STATION, TX 77845-5812
(979) 776-6060
(979) 776-6172
Mailing address
3312 LONGMIRE DR, COLLEGE STATION, TX 77845-5812
(979) 776-6060
(979) 776-6172
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080873501
—
TX
Enumeration date
02/01/2019
Last updated
02/01/2019
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