Provider Demographics
NPI:1497215438
Name:SANDBERG FOOT HEALTH CENTER PC
Entity Type:Organization
Organization Name:SANDBERG FOOT HEALTH CENTER PC
Other - Org Name:VOLUNTEER PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:365-523-5655
Mailing Address - Street 1:9301 PARK WEST BLVD STE A2
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4300
Mailing Address - Country:US
Mailing Address - Phone:865-523-5655
Mailing Address - Fax:865-523-4882
Practice Address - Street 1:116 CONCORD RD STE 300
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2941
Practice Address - Country:US
Practice Address - Phone:865-523-5655
Practice Address - Fax:865-523-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty