Provider Demographics
NPI:1639376221
Name:SCHUSSLER FOOTCARE CENTERS, PLC
Entity Type:Organization
Organization Name:SCHUSSLER FOOTCARE CENTERS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACALYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHUSSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-552-3338
Mailing Address - Street 1:1762 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4562
Mailing Address - Country:US
Mailing Address - Phone:931-552-3338
Mailing Address - Fax:931-647-4358
Practice Address - Street 1:1762 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4562
Practice Address - Country:US
Practice Address - Phone:931-552-3338
Practice Address - Fax:931-647-4358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0305213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1942200076OtherINDV NPI NUMBER
TN3353012Medicaid
TN1639376221OtherGROUP NPI
TN3040221OtherBCBS
TN1639376221OtherGROUP NPI
TN3040221OtherBCBS
TN3353012Medicare PIN