Provider Demographics
NPI:1952404964
Name:PREMIER FOOTCARE PC
Entity Type:Organization
Organization Name:PREMIER FOOTCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARELYN
Authorized Official - Middle Name:T
Authorized Official - Last Name:CREAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:615-321-2711
Mailing Address - Street 1:PO BOX 11573
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0032
Mailing Address - Country:US
Mailing Address - Phone:615-321-2711
Mailing Address - Fax:615-534-4784
Practice Address - Street 1:131 FRENCH LANDING DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1511
Practice Address - Country:US
Practice Address - Phone:615-321-2711
Practice Address - Fax:615-534-4784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN619TN213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730595Medicaid
TN3730595Medicare PIN
TN3730595Medicaid