Provider Demographics
NPI:1518094085
Name:TOTAL FOOT CARE, INC. OF TENNESSEE
Entity Type:Organization
Organization Name:TOTAL FOOT CARE, INC. OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:TEAKO
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:901-523-7698
Mailing Address - Street 1:1204 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2226
Mailing Address - Country:US
Mailing Address - Phone:901-523-7698
Mailing Address - Fax:901-272-2045
Practice Address - Street 1:1204 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2226
Practice Address - Country:US
Practice Address - Phone:901-523-7698
Practice Address - Fax:901-272-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN652213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4142034OtherBCBST
TN3354184Medicaid
5846550001Medicare NSC
TN3736397Medicare PIN
TN3354184Medicaid