Provider Demographics
NPI:1811274624
Name:RICHARD S EBY DPM
Entity type:Organization
Organization Name:RICHARD S EBY DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:EBY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:423-942-6604
Mailing Address - Street 1:11A COURTHOUSE SQ
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3531
Mailing Address - Country:US
Mailing Address - Phone:423-942-6604
Mailing Address - Fax:423-622-8172
Practice Address - Street 1:11A COURTHOUSE SQ
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3531
Practice Address - Country:US
Practice Address - Phone:423-942-6604
Practice Address - Fax:423-622-8172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000238213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6364350002Medicare NSC