Provider Demographics
NPI:1679628127
Name:WILLIAM M. STEELY
Entity Type:Organization
Organization Name:WILLIAM M. STEELY
Other - Org Name:STEELY FOOT CLINIC, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEELY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:731-285-3338
Mailing Address - Street 1:575 MALL BLVD
Mailing Address - Street 2:SUITE L2
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1661
Mailing Address - Country:US
Mailing Address - Phone:731-285-3338
Mailing Address - Fax:731-286-6331
Practice Address - Street 1:575 MALL BLVD
Practice Address - Street 2:SUITE L2
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1661
Practice Address - Country:US
Practice Address - Phone:731-285-3338
Practice Address - Fax:731-286-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000571213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727102Medicaid
TN4862710001Medicare NSC
TN3727102Medicaid