Provider Demographics
NPI:1245287002
Name:PODIATRY CENTERS OF MEMPHIS PC
Entity type:Organization
Organization Name:PODIATRY CENTERS OF MEMPHIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:KIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:901-763-0461
Mailing Address - Street 1:995 S YATES RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0882
Mailing Address - Country:US
Mailing Address - Phone:901-763-0461
Mailing Address - Fax:901-681-9820
Practice Address - Street 1:995 S YATES RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0882
Practice Address - Country:US
Practice Address - Phone:901-763-0461
Practice Address - Fax:901-681-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1316931272OtherNPI BRIAN N. KIEL
1386639789OtherNPI DAVID M. MOINESTER
CC4980OtherRAILROAD MEDICARE
1386639789OtherNPI DAVID M. MOINESTER
TN3351647Medicare ID - Type UnspecifiedPRACTICE
TN3351648Medicare ID - Type UnspecifiedPRACTICE
TN3351649Medicare ID - Type UnspecifiedPRACTICE
TN0891860001Medicare NSC