Provider Demographics
NPI:1780699249
Name:ADVANCED FOOT CARE CENTER, PC
Entity type:Organization
Organization Name:ADVANCED FOOT CARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VELARDE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:865-523-1141
Mailing Address - Street 1:2824 MERCHANTS DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-4905
Mailing Address - Country:US
Mailing Address - Phone:865-523-1145
Mailing Address - Fax:865-521-6635
Practice Address - Street 1:2824 MERCHANTS DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-4905
Practice Address - Country:US
Practice Address - Phone:865-521-6635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN631213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8893748OtherCIGNA
TNP00182231OtherRAIL ROAD MEDICARE
TNTN0102OtherUNITED HEALTHCARE
TN7644655OtherAETNA
TN3726396Medicaid
TN4099765OtherBLUE CROSS BLUE SHIELD
TNU68914Medicare UPIN
TN3726396Medicare PIN
TN3726396Medicaid