Provider Demographics
NPI:1629408703
Name:JOHN N. GERNERT
Entity Type:Organization
Organization Name:JOHN N. GERNERT
Other - Org Name:CLEVELAND FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/AM
Authorized Official - Prefix:MS
Authorized Official - First Name:TANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-476-3773
Mailing Address - Street 1:105 KEITH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-1704
Mailing Address - Country:US
Mailing Address - Phone:423-476-3773
Mailing Address - Fax:423-476-8529
Practice Address - Street 1:105 KEITH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-1704
Practice Address - Country:US
Practice Address - Phone:423-476-3773
Practice Address - Fax:423-476-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000198213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1629408703Medicaid
TN3350757OtherPTAN
TNT61072OtherUPIN
TN103G70335Medicaid
TN1194867580OtherNPI
TN2009413OtherBLUECARE/TENNCARE