Provider Demographics
NPI:1861683351
Name:TENNESSEE VALLEY FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:TENNESSEE VALLEY FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STRICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:423-559-8000
Mailing Address - Street 1:709 CANDLEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2064
Mailing Address - Country:US
Mailing Address - Phone:423-559-8000
Mailing Address - Fax:423-550-8017
Practice Address - Street 1:3000 WESTSIDE DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3542
Practice Address - Country:US
Practice Address - Phone:423-559-8000
Practice Address - Fax:423-559-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000480213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4033978OtherBCBS
TN3353543Medicaid
GA035007OtherBCBS
GA000959857AMedicaid
GACK8464OtherMEDICARE RR
TN4759250001Medicare NSC
TN4033978OtherBCBS
TN3353543Medicaid
GA000959857AMedicaid
GA4759250002Medicare NSC