Provider Demographics
NPI:1578767224
Name:CENTRAL TENNESSEE FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:CENTRAL TENNESSEE FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:931-738-1026
Mailing Address - Street 1:415 SEWELL DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1223
Mailing Address - Country:US
Mailing Address - Phone:931-738-1026
Mailing Address - Fax:931-738-1027
Practice Address - Street 1:415 SEWELL DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1223
Practice Address - Country:US
Practice Address - Phone:931-738-1026
Practice Address - Fax:931-738-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0671213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0671OtherMEDICAL LICENSE
TN0671OtherMEDICAL LICENSE