Provider Demographics
NPI:1821198318
Name:WILLIAM D TENNEY
Entity Type:Organization
Organization Name:WILLIAM D TENNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:TENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-974-3338
Mailing Address - Street 1:8899 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6211
Mailing Address - Country:US
Mailing Address - Phone:440-974-3338
Mailing Address - Fax:
Practice Address - Street 1:8899 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6211
Practice Address - Country:US
Practice Address - Phone:440-974-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-24
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001599213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0232948Medicaid
OH274388804003OtherMEDICAL MUTUAL OF OHIO
OH480031264BOtherRR MEDICARE
OH274388804003OtherMEDICAL MUTUAL OF OHIO
OH0493660001Medicare NSC
OH274388804003OtherMEDICAL MUTUAL OF OHIO
OH0232948Medicaid