Provider Demographics
NPI:1891720462
Name:TENNESSEE FOOT & ANKLE CLINIC, INC.
Entity Type:Organization
Organization Name:TENNESSEE FOOT & ANKLE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HAWK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:865-986-2700
Mailing Address - Street 1:125 TOWN CREEK RD E
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5612
Mailing Address - Country:US
Mailing Address - Phone:865-986-2700
Mailing Address - Fax:986-986-8096
Practice Address - Street 1:125 TOWN CREEK RD E
Practice Address - Street 2:SUITE 3
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5612
Practice Address - Country:US
Practice Address - Phone:865-986-2700
Practice Address - Fax:986-986-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3353617Medicare PIN
4597160001Medicare NSC