Basic Information
| Provider Information | |||||||||
| NPI: | 1669493284 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEDGER FOOT & ANKLE, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11538 | ||||||||
| Address2: | |||||||||
| City: | KILLEEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765471538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542459177 | ||||||||
| FaxNumber: | 2542459178 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 W CENTRAL TEXAS EXPY | ||||||||
| Address2: | SUITE 155 | ||||||||
| City: | HARKER HEIGHTS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765481899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2545193668 | ||||||||
| FaxNumber: | 2545013668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 03/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | LEDGER | ||||||||
| AuthorizedOfficialFirstName: | H. | ||||||||
| AuthorizedOfficialMiddleName: | ASHLEY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2545193668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | DC0070 | 01 | TX | MEDICARE RAILROAD | OTHER | 0066LE | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 166302301 | 05 | TX | MEDICAID |