Provider Demographics
NPI:1952498362
Name:DR. WM. D. TENNEY
Entity Type:Organization
Organization Name:DR. WM. D. TENNEY
Other - Org Name:SOLON FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WM.
Authorized Official - Middle Name:D
Authorized Official - Last Name:TENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-248-3374
Mailing Address - Street 1:6440 S.O.M. CENTER RD.
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139
Mailing Address - Country:US
Mailing Address - Phone:440-248-3374
Mailing Address - Fax:
Practice Address - Street 1:6440 S.O.M. CENTER RD.
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139
Practice Address - Country:US
Practice Address - Phone:440-248-3374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-10-10
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
OH274388804002OtherMEDICAL MUTUAL OF OHIO
OH480012319OtherRR MEDICARE
OH0232948Medicaid
OH480012319OtherRR MEDICARE
OH=========300OtherBWC
OH274388804002OtherMEDICAL MUTUAL OF OHIO
OH0493660002Medicare NSC