Provider Demographics
NPI:1841027588
Name:FOOT AND ANKLE CLINIC OF EAST TENNESSEE
Entity type:Organization
Organization Name:FOOT AND ANKLE CLINIC OF EAST TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELELTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-406-5716
Mailing Address - Street 1:PO BOX 22323
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37933-0323
Mailing Address - Country:US
Mailing Address - Phone:865-329-3338
Mailing Address - Fax:865-329-3333
Practice Address - Street 1:2725 ASBURY RD STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-6436
Practice Address - Country:US
Practice Address - Phone:865-329-3338
Practice Address - Fax:865-329-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty