Brazos Foot and Ankle Clinic P.a.
Organization Active NPI Podiatrist · Granbury, TX
NPI 1851399893 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1851399893
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- Legal business name
- BRAZOS FOOT AND ANKLE CLINIC P.A.
- Practice address
- 1201 Medical Plaza CT
Granbury, TX 76048-5684 - Phone
- (817) 578-8555
- Fax
- (817) 573-6234
- NPI assigned
- Jul 13, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Shannon Ray Mueller
- Title
- D.P.M.
- Phone
- (817) 578-8555
Practitioners 2
-
Shannon Ray Mueller, D.P.M.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040108001066 | TX | Part B Supplier - Clinic/Group Practice | 6204736119 |
Receives reassigned benefits from 1 practitioner Practice locations: Granbury, TX |
| O20100930094696 | TX | DME Supplier - Physician - Podiatry | 6204736119 | Practice locations: Granbury, TX |
National Provider Directory
Locations
710 Paluxy Rd
Granbury, TX 76048
Phone (817) 279-9044
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | TX | Yes |
Addresses
Primary practice location
1201 Medical Plaza CT
Granbury, TX 76048-5684
Mailing address
1201 Medical Plaza CT
Granbury, TX 76048-5684
Phone (817) 578-8555
Other providers in Granbury, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.