Provider Demographics
NPI:1891204087
Name:MENDOZA FOOT & ANKLE CENTER PC
Entity Type:Organization
Organization Name:MENDOZA FOOT & ANKLE CENTER PC
Other - Org Name:NASHVILLE PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:615-452-8899
Mailing Address - Street 1:336 SUMNER HALL DR
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3129
Mailing Address - Country:US
Mailing Address - Phone:615-452-8899
Mailing Address - Fax:615-452-8919
Practice Address - Street 1:353 NEW SHACKLE ISLAND RD STE 203A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2371
Practice Address - Country:US
Practice Address - Phone:615-822-9651
Practice Address - Fax:615-822-9655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM000000442213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3352215Medicaid