| NPI | 1649471467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN LUCAS President 901-309-8898 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery |
| Additional Taxonomies | 293D00000X Physiological Laboratory |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 261QP2000X Clinic/Center Physical Therapy | |
| 261QP3300X Clinic/Center Pain | |
| 3336C0002X Pharmacy Clinic Pharmacy | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2020-04-09 |