Healthcare Provider Details

I. General information

NPI: 1649471467
Provider Name (Legal Business Name): ADVANCED FOOT & ANKLE CARE OF MEMPHIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 KIRBY RD SUITE 5
MEMPHIS TN
38119-8221
US

IV. Provider business mailing address

2900 KIRBY RD SUITE 5
MEMPHIS TN
38119-8221
US

V. Phone/Fax

Practice location:
  • Phone: 901-309-8898
  • Fax: 901-309-5908
Mailing address:
  • Phone: 901-309-8898
  • Fax: 901-309-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NATHAN LUCAS
Title or Position: PRESIDENT
Credential: DPM
Phone: 901-309-8898