Provider Demographics
NPI:1871513770
Name:ANDREW CASSIDY PA
Entity type:Organization
Organization Name:ANDREW CASSIDY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:P
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-263-5454
Mailing Address - Street 1:3944 S FM 620
Mailing Address - Street 2:BUILDING 6, STE 204
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738
Mailing Address - Country:US
Mailing Address - Phone:512-263-5454
Mailing Address - Fax:512-263-5454
Practice Address - Street 1:3944 S FM 620,
Practice Address - Street 2:BUILDING 6, STE 204
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738
Practice Address - Country:US
Practice Address - Phone:512-263-5454
Practice Address - Fax:512-263-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1671213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R7150OtherBLUE CROSS BLUE SHIELD
TX8R7150OtherBLUE CROSS BLUE SHIELD
TX00120YMedicare PIN
TX5395390001Medicare NSC