Provider Demographics
NPI:1437306198
Name:MIDDLE TENNESSEE FOOT ASSOCIATES P C
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE FOOT ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:SUPERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:931-728-3988
Mailing Address - Street 1:108 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-1563
Mailing Address - Country:US
Mailing Address - Phone:931-728-3988
Mailing Address - Fax:931-728-6530
Practice Address - Street 1:108 N SPRING ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-1563
Practice Address - Country:US
Practice Address - Phone:931-728-3988
Practice Address - Fax:931-728-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN246213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5707200001Medicare NSC