1578672291 NPI number — DEPENNDABLE FOOTCARE, PC

Table of content: MS. ESTELLA THOMPKINS BROWN LMSW (NPI 1215526918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578672291 NPI number — DEPENNDABLE FOOTCARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPENNDABLE FOOTCARE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578672291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 17798
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37217-2543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-243-7636
Provider Business Mailing Address Fax Number:
615-225-2811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3408 BRIDGETON COVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTIOCH
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-321-2711
Provider Business Practice Location Address Fax Number:
615-321-2714
Provider Enumeration Date:
08/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PENN
Authorized Official First Name:
MILTON
Authorized Official Middle Name:
EARL
Authorized Official Title or Position:
PODIATRIST/OWNER
Authorized Official Telephone Number:
615-243-7636

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  DPM0000000452 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: DPM452 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3734591 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4123039 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".