Provider Demographics
NPI:1356510473
Name:LISLE SNYDER, DPM
Entity Type:Organization
Organization Name:LISLE SNYDER, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-543-8719
Mailing Address - Street 1:PO BOX 812
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37644-0812
Mailing Address - Country:US
Mailing Address - Phone:423-543-8719
Mailing Address - Fax:
Practice Address - Street 1:207 W G ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3113
Practice Address - Country:US
Practice Address - Phone:423-543-8719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2006277OtherBCBS
TN2006277OtherBLUE CARE
TNTN0101OtherMEDICARE COMPLETE
TN2006277OtherBLUE CARE
TNU05847Medicare UPIN
TN3353048Medicare PIN
TN3350528Medicare PIN