Provider Demographics
NPI:1578672291
Name:DEPENNDABLE FOOTCARE, PC
Entity Type:Organization
Organization Name:DEPENNDABLE FOOTCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:PENN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:615-243-7636
Mailing Address - Street 1:P.O. BOX 17798
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2543
Mailing Address - Country:US
Mailing Address - Phone:615-243-7636
Mailing Address - Fax:615-225-2811
Practice Address - Street 1:3408 BRIDGETON COVE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013
Practice Address - Country:US
Practice Address - Phone:615-321-2711
Practice Address - Fax:615-321-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000452213ES0103X
TNDPM452213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3734591Medicaid
TN4123039OtherBCBS
TN3734591Medicaid
TN5793960001Medicare NSC
TN3734591Medicare PIN
TN5793960001Medicare PIN