TACKLE MANAGEMENT CORPORATION NPI 1033399688

NPI Information

  • NPI: 1033399688
  • Provider Name: TACKLE MANAGEMENT CORPORATION
  • Classification: Podiatrist - 213ES0103X
  • Specialization: Foot & Ankle Surgery
  • Entity Type: Organization
  • Doing Business As: BULL RUN FOOT CLINIC
  • Address: 8637 MATHIS AVE
    MANASSAS, VA
    ZIP 20110
  • Phone: (703) 335-6890

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NPI Details

TACKLE MANAGEMENT CORPORATION is a foot and ankle surgery podiatrist in Manassas, VA. TACKLE MANAGEMENT CORPORATION NPI is 1033399688. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Bull Run Foot Clinic.

The provider's business location address is:

8637 MATHIS AVE
MANASSAS, VA
ZIP 20110-270
Phone: (703) 335-6890

The provider's authorized official is Theresa Lynn Coates .
The authorized official title is Practice Administrator and has the following contact phone number (703) 368-1800.

The enumeration date for this NPI number is 11/13/2007 and was last updated on 11/13/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1213ES0103XPodiatristFoot & Ankle SurgeryVIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1296209OTHERVIRGINIAANTHEM

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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