Organization
NORTH CENTRAL TEXAS FOOT & ANKLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKY CHILDERS (OFFICER)
(415) 730-5058
Entity
Organization
Contact information
Practice address
1713 S FM 51, SUITE 103, DECATUR, TX 76234-3642
(940) 627-6976
(940) 627-3491
Mailing address
1713 S FM 51, SUITE 103, DECATUR, TX 76234-3642
(940) 627-6976
(940) 627-3491
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
1932
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039ZP
BCBSTX
TX
05
—
334277601
—
TX
Enumeration date
12/31/2013
Last updated
06/04/2019
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