WOLF RIVER FAMILY FOOTCARE PLLC NPI 1457480683

NPI Information

NPI: 1457480683
Provider Name: WOLF RIVER FAMILY FOOTCARE PLLC
Classification: Podiatrist - 213ES0103X
Entity Type: Organization

Specialization: Foot & Ankle Surgery

Address:
7424 US HIGHWAY 64
SUITE 119
BARTLETT, TN
ZIP 38133
Phone: (901) 381-2800
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WOLF RIVER FAMILY FOOTCARE PLLC is a foot and ankle surgery podiatrist in Bartlett, TN. WOLF RIVER FAMILY FOOTCARE PLLC NPI is 1457480683. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

7424 US HIGHWAY 64
SUITE 119
BARTLETT, TN
ZIP 38133-986
Phone: (901) 381-2800
Fax: (901) 381-2677

The provider's authorized official is Carl Joseph Siciliano .
The authorized official title is Owner Sole Member and has the following contact phone number (901) 381-2800.

The enumeration date for this NPI number is 3/5/2007 and was last updated on 6/5/2008.

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
1	213ES0103X	Podiatrist	Foot & Ankle Surgery	DPM0000000422	TENNESSEE	Yes

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
1	6041020001	MEDICARE NSC
2	DG7179	OTHER	TENNESSEE	MEDICARE ID TYPE UNSPECIFIED
3	33519762	MEDICARE PIN

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: 5/5/2024

NPI Synchronization or Removal

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