Provider Demographics
NPI:1902997398
Name:AFCOA KINGWOOD, PC
Entity Type:Organization
Organization Name:AFCOA KINGWOOD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-265-9884
Mailing Address - Street 1:1414 GREEN OAK TERRACE CT STE 100
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2960
Mailing Address - Country:US
Mailing Address - Phone:281-358-9889
Mailing Address - Fax:281-358-1465
Practice Address - Street 1:1414 GREEN OAK TERRACE CT
Practice Address - Street 2:100
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2960
Practice Address - Country:US
Practice Address - Phone:281-358-9889
Practice Address - Fax:281-358-1465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0713213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092844201Medicaid
TX092844201Medicaid
TX0A6107Medicare PIN