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NPI Code Detail

MEDICARE: PREMIER FOOTCARE PC

MEDICARE: PREMIER FOOTCARE PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist619TNTN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952404964
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER FOOTCARE PC
Provider Business Mailing Address
First Line : PO BOX 11573
Second Line :
City : MURFREESBORO
State : TN
Zip : 37129-0032
Country : US
Telephone Number : 615-321-2711
Fax Number : 615-534-4784
Provider Business Practice Location Address
First Line : 131 FRENCH LANDING DR
Second Line :
City : NASHVILLE
State : TN
Zip : 37228-1511
Country : US
Telephone Number : 615-321-2711
Fax Number : 615-534-4784
Authorized Official
Title or Position : OWNER PRESIDENT
Name : DR. LARELYN T CREAR
Credential : DPM
Telephone Number : 615-321-2711
Provider Enumeration Date : 09/06/2006
Last Update Date : 09/27/2019

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