Provider Demographics
NPI:1609207117
Name:KNOXVILLE FOOT AND ANKLE, LLC
Entity Type:Organization
Organization Name:KNOXVILLE FOOT AND ANKLE, LLC
Other - Org Name:SWCA OF TN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DELEGATED OFFICAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-985-2260
Mailing Address - Street 1:1415 OLD WEISGARBER RD STE 350
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1381
Mailing Address - Country:US
Mailing Address - Phone:304-629-9868
Mailing Address - Fax:
Practice Address - Street 1:1919 PINNACLE POINTE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6701
Practice Address - Country:US
Practice Address - Phone:877-380-2072
Practice Address - Fax:208-383-5306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002214Medicaid