Excelsior Podiatry Clinic PLLC
Exclusive Provider Organization in Somerville, TN. Organization (NPI-2).
NPI number1124350087
StatusActive
Last updated in NPPESFeb 3, 2010
Details
- NPI
- 1124350087
- Entity type
- Organization (NPI-2)
- Legal business name
- Excelsior Podiatry Clinic PLLC
- Organization subpart
- No
- Enumeration date
- Feb 3, 2010
- Last updated
- Feb 3, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 302F00000X | Exclusive Provider Organization | DPM0000000649 | TN | Yes |
Practice location
214 Lakeview RdSomerville, TN 38068-9737
Phone 901-516-4005 · Fax 901-516-4023
Mailing address
Po Box 460Oakland, TN 38060-0460
Phone 901-516-4005 · Fax 901-516-4023
Authorized official
John Elijah Bell
Ceo, President
9015164005
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