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General NPI Number Information
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NPI Number | 1437297595
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Entity Type | Organization
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Legal Business Name | OLIVER FOOT CLINIC, INC.
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 12/29/2009
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Provider Practice Location Address
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Address Line | 635 N. MAIN STREET SUITE A
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City | SHELBYVILLE
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State | TN
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Zip | 37160-3235
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Country | US
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Telephone | 931-684-8884
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Fax | 931-684-8808
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Provider Business Mailing Address
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Address Line | P.O. BOX 766
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City | SHELBYVILLE
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State | TN
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Zip | 37162-0766
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Country | US
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Telephone | 931-684-8884
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Fax | 931-684-8808
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. RUSSELL WADE OLIVER
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Credential | DPM
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Telephone | 931-684-8884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | DPM0000000524
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License Number State | TN
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