Provider Demographics
NPI:1730169434
Name:GENTLE FOOT CARE INC
Entity type:Organization
Organization Name:GENTLE FOOT CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-544-2238
Mailing Address - Street 1:1021 EXECUTIVE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-7907
Mailing Address - Country:US
Mailing Address - Phone:423-877-0050
Mailing Address - Fax:423-877-7791
Practice Address - Street 1:1021 EXECUTIVE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7918
Practice Address - Country:US
Practice Address - Phone:423-877-0050
Practice Address - Fax:423-877-7791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3353471Medicaid
TNU62637Medicare UPIN
TN3352729Medicaid