MEDICARE: DR. KEVIN W DAVIS DPM

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
1	213E00000X	Podiatrist	00302	KY
2	213ES0131X	Foot Surgery Podiatrist	302	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00419400	OTHER	KY	RAILROAD MEDICARE
7	DF9516	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	4179406	OTHER	BLUE CROSS BLUE SHIELD TENNESSEE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326047119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN W DAVIS DPM

Provider Business Mailing Address
First Line	:	PO BOX 1455
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-1455
Country	:	US
Telephone Number	:	615-382-8056
Fax Number	:	615-382-8056

Provider Business Practice Location Address
First Line	:	312 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3963
Country	:	US
Telephone Number	:	615-384-3112
Fax Number	:	615-382-7332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	07/10/2008

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Directions to “ DR. KEVIN W DAVIS DPM” Practice Location

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