Provider Demographics
NPI:1649471467
Name:ADVANCED FOOT & ANKLE CARE OF MEMPHIS, LLC
Entity type:Organization
Organization Name:ADVANCED FOOT & ANKLE CARE OF MEMPHIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:901-309-8898
Mailing Address - Street 1:2900 KIRBY RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8221
Mailing Address - Country:US
Mailing Address - Phone:901-309-8898
Mailing Address - Fax:901-309-5908
Practice Address - Street 1:2900 KIRBY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8221
Practice Address - Country:US
Practice Address - Phone:901-309-8898
Practice Address - Fax:901-309-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4259570001OtherDMERC
TN3382581Medicare PIN
TN4259570001OtherDMERC
TNU42202Medicare UPIN