Provider Demographics
NPI:1376723163
Name:ASSOCIATED PODIATRISTS OF TENNESSEE
Entity Type:Organization
Organization Name:ASSOCIATED PODIATRISTS OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:BABU
Authorized Official - Last Name:PAVULURI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:931-553-0634
Mailing Address - Street 1:100 MEDICAL CENTER CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4546
Mailing Address - Country:US
Mailing Address - Phone:931-553-0634
Mailing Address - Fax:931-553-0103
Practice Address - Street 1:100 MEDICAL CENTER CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4546
Practice Address - Country:US
Practice Address - Phone:931-553-0634
Practice Address - Fax:931-553-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM406213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3352104Medicare PIN
TN0796620002Medicare NSC