Provider Demographics
NPI:1053461087
Name:SANDBERG FOOT HEALTH CENTER PC
Entity Type:Organization
Organization Name:SANDBERG FOOT HEALTH CENTER PC
Other - Org Name:VOLUNTEER PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:865-523-5655
Mailing Address - Street 1:9301 PARK WEST BLVD STE A2
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4300
Mailing Address - Country:US
Mailing Address - Phone:865-523-5655
Mailing Address - Fax:865-523-4882
Practice Address - Street 1:501 19TH ST STE 601
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1852
Practice Address - Country:US
Practice Address - Phone:865-523-5655
Practice Address - Fax:865-523-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN521213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5295730001Medicare NSC
U65915Medicare UPIN
TN5295730002Medicare NSC
3714132Medicare ID - Type Unspecified
3714132Medicare PIN