Provider Demographics
NPI:1225208689
Name:PAULO R.T. YEN
Entity Type:Organization
Organization Name:PAULO R.T. YEN
Other - Org Name:DBA TLC FAMILY FOOTCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULO
Authorized Official - Middle Name:RT
Authorized Official - Last Name:YEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:931-648-9852
Mailing Address - Street 1:1823 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4604
Mailing Address - Country:US
Mailing Address - Phone:931-648-9852
Mailing Address - Fax:931-906-8528
Practice Address - Street 1:1823 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4604
Practice Address - Country:US
Practice Address - Phone:931-648-9852
Practice Address - Fax:931-906-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-01
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM336261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3351486Medicaid
TN4109056OtherBC/BS
TNT39024Medicare UPIN
TN5500750001Medicare NSC
TN3351486Medicaid