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NPI Code Detail

MEDICARE: GATEWAY FOOT AND ANKLE CENTER, PLC

MEDICARE: GATEWAY FOOT AND ANKLE CENTER, PLC
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
1213ES0103XFoot & Ankle Surgery Podiatrist

General Provider Information

NPI Number : 1760812440
Entity Type Code : Organization
Provider Name (Legal Business Name) : GATEWAY FOOT AND ANKLE CENTER, PLC
Provider Business Mailing Address
First Line : 647 DUNLOP LN
Second Line : SUITE 209
City : CLARKSVILLE
State : TN
Zip : 37040-5165
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 313 N MAIN ST
Second Line : SUITE 1J
City : ASHLAND CITY
State : TN
Zip : 37015-1347
Country : US
Telephone Number : 931-245-1920
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DAVID E SMITH
Credential : DPM
Telephone Number : 931-245-1920
Provider Enumeration Date : 11/18/2013
Last Update Date : 11/18/2013

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