NPI 1124350087

Excelsior Podiatry Clinic PLLC

Organisation Exclusive Provider Organization Somerville, TN

Practice location

Address: 214 Lakeview Rd, Somerville, TN 38068-9737
Phone: (901) 516-4005
Fax: (901) 516-4023
Mailing address: PO Box 460, Oakland, TN 38060-0460

Authorised official

Name: John Elijah Bell
Title: Ceo, President
Phone: (901) 516-4005

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence DPM0000000649 (TN)

Other Exclusive Provider Organization providers in Tennessee →

Registry record

NPI: 1124350087
Entity type: Organization
NPI issued: 3 Feb 2010
Record last updated: 3 Feb 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.