Provider Demographics
NPI:1699787994
Name:EAST TENNESSEE FOOT CONSULTANTS
Entity type:Organization
Organization Name:EAST TENNESSEE FOOT CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:865-691-1115
Mailing Address - Street 1:9330 PARK WEST BLVD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4308
Mailing Address - Country:US
Mailing Address - Phone:865-691-1115
Mailing Address - Fax:865-691-8055
Practice Address - Street 1:9330 PARK WEST BLVD
Practice Address - Street 2:SUITE 508
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4308
Practice Address - Country:US
Practice Address - Phone:865-691-1115
Practice Address - Fax:865-691-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM000312213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3351462Medicare ID - Type UnspecifiedM'CARE GROUP #