LIBERTY DAYTON FOOT & ANKLE CENTER (NPI# 1689603805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689603805 |
| Entity Type | Organization |
| Organization Name | LIBERTY DAYTON FOOT & ANKLE CENTER |
| Other Organization Name | LIBERTY DAYTON FOOT & ANKLE CENTER |
| Practice Address |
1825 Grand Ave Liberty TX 77575-4705 |
| Mailing Address |
Po Box 1160 Liberty TX 77575-1160 |
| Practice Telephone | 9363362633 |
| Practice Fax Number | 9363366031 |
| Mailing Telephone | 2814444114 |
| Mailing Fax Number | 2814531269 |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2009-06-19 |
| Authorized Official Name | DR. LAWRENCE S MACTAVISH (PHYSICIAN OWNER) |
| Authorized Official Telephone | 9363362633 |
| Authorized Official Credential | D.P.M. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | 506 | TX | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | RR MEDICARE | DG6815 | 01 |
| TX | 199497201 | 05 | |
| TX | BCBS | 00J24P | 01 |
| TX | 121574103 | 05 |
| Other Name | Type Code |
|---|---|
| LIBERTY DAYTON FOOT & ANKLE CENTER | Doing Business As Name - Organization |
| Street Address |
1825 GRAND AVE |
| City | LIBERTY |
| State | TX |
| Zip Code | 77575-4705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750981502 | Parikshit Jayant Davda | Clinic/Center | 1620 Magbolia Street, Liberty, TX 77575 | 2020-10-30 |
| 1003285156 | Divine Garden Transportation | Non-emergency Medical Transport (VAN) | 450 Mlking Dr., Liberty, TX 77575 | 2015-09-18 |
| 1689895799 | Allen R. Griffin | Eyewear Supplier (Equipment, not the service) | 2718 B N. Main St., Liberty, TX 77575 | 2007-05-02 |
| 1548362395 | Hsmtx/liberty, LLC | Skilled Nursing Facility | 1206 N Travis St, Liberty, TX 77575 | 2006-09-02 |
| 1699877530 | Lessie Frank | Licensed Vocational Nurse | 612 Highway 90, Liberty, TX 77575 | 2006-09-01 |
| 1588601827 | Trudy Poor Britz | Nurse Practitioner | 1807 Rampart, League, TX 77575 | 2006-06-02 |
| 1285680033 | Faresh Mehta | Optometrist | 2121 Hwy 146 Bypass, Liberty, TX 77575 | 2006-05-25 |
| 1922455781 | Bassam A. Hamid M.d.,p.a. Urgent Care/primarycare | Clinic/Center | 608 Travis, Liberty, TX 77575 | 2016-05-20 |
| 1508887241 | Tri-county Behavioral Healthcare | Intermediate Care Facility, Mentally Retarded | 1420 Holly St, Liberty, TX 77575-3118 | 2006-07-21 |
| 1528581220 | D&s Residential Services, Lp | Intermediate Care Facility, Mentally Retarded | 1420 Holly St, Liberty, TX 77575-3118 | 2017-07-25 |
| Find all providers in zip 77575 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437159217 | Thomas Craig Boldry | Podiatrist | 550 Rush Creek Pkwy, Suite A, Liberty, MO 64068-9608 | 2005-07-22 |
| 1649711524 | Dare Foot Care LLC | Podiatrist | 2201 Glenn Hendren Dr, Liberty, MO 64068-3375 | 2017-03-13 |
| 1801896600 | Julie Jeanette Jones | Podiatrist | 550 Rush Creek Pkwy, Suite A, Liberty, MO 64068-9608 | 2005-07-22 |
| 1629078407 | Paul Owen Gorby | Podiatrist | 550 Rush Creek Pkwy, Suite A, Liberty, MO 64068-9608 | 2005-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891396834 | Shine Foot and Ankle Center | Podiatrist | 11614 Fm 2244 Rd Ste 150, Austin, TX 78738-5471 | 2020-11-05 |
| 1740895911 | Royal Haven Medical | Podiatrist | 713 Lakeview Dr, Alvarado, TX 76009-2668 | 2020-09-14 |
| 1851924500 | Interventional Partners LLC | Podiatrist | 4708 Alliance Blvd Ste 475, Plano, TX 75093-5351 | 2020-02-20 |
| 1225688583 | Access Podiatry Center, LLC | Podiatrist | 2703 Stone Hedge, Eagle Pass, TX 78852 | 2019-09-18 |
| 1366091704 | Carrollton Podiatrist Pllc | Podiatrist | 3730 N Josey Ln Ste 120, Carrollton, TX 75007-2439 | 2019-09-09 |
| 1760030571 | Right Step Foot Clinic and Ankle Clinic, LLC | Podiatrist | 11507 S Highway 6 Ste C, Sugar Land, TX 77498-4933 | 2019-08-27 |
| 1225684392 | Podiatry Usa Corporation | Podiatrist | 2300 Sherbrooke Ln, Mckinney, TX 75070-4769 | 2019-08-14 |
| 1508422395 | Interventional Partners | Podiatrist | 3200 Olton Rd Ste C, Plainview, TX 79072-6653 | 2019-05-16 |
| 1194380097 | Interventional Partners LLC | Podiatrist | 5575 Warren Pkwy Ste 101, Frisco, TX 75034-4066 | 2019-05-06 |
| 1548825839 | Interventional Partners LLC | Podiatrist | 2150 N Josey Ln # 200b, Carrollton, TX 75006-2991 | 2019-05-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.