MEDICARE: TOTAL FOOT CARE, INC. OF TENNESSEE

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	213ES0131X	Foot Surgery Podiatrist	652	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4142034	OTHER	TN	BCBST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518094085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL FOOT CARE, INC. OF TENNESSEE

Provider Business Mailing Address
First Line	:	1204 MADISON AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-2226
Country	:	US
Telephone Number	:	901-523-7698
Fax Number	:	901-272-2045

Provider Business Practice Location Address
First Line	:	1204 MADISON AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-2226
Country	:	US
Telephone Number	:	901-523-7698
Fax Number	:	901-272-2045

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. TYRONE TEAKO DAVIS
Credential	:	DPM
Telephone Number	:	901-523-7698

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/18/2010

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