Provider Demographics
NPI:1093770521
Name:PIEDMONT PODIATRY ASSOCIATES
Entity Type:Organization
Organization Name:PIEDMONT PODIATRY ASSOCIATES
Other - Org Name:PIEDMONT FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-632-5280
Mailing Address - Street 1:15 CLEVELAND AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2937
Mailing Address - Country:US
Mailing Address - Phone:276-632-5280
Mailing Address - Fax:276-632-5257
Practice Address - Street 1:15 CLEVELAND AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2937
Practice Address - Country:US
Practice Address - Phone:276-632-5280
Practice Address - Fax:276-632-5257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA449213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT64039Medicare UPIN
VAU02680Medicare UPIN
VA0611010005Medicare NSC