MEDICARE: DR. CHARLES D GANIME D.P.M.

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	DPM0000000591	TN
2	213ES0103X	Foot & Ankle Surgery Podiatrist	DPM0000000591	TN
3	213ES0131X	Foot Surgery Podiatrist	DPM0000000591	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4043822	OTHER	TN	BCBS PROVIDER NUMBER
2	2740157	OTHER	TN	UNITED HEALTHCARE PROV. #
3	7641364	OTHER	TN	AETNA PROVIDER NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861496853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES D GANIME D.P.M.

Provider Business Mailing Address
First Line	:	155 HOSPITAL RD
Second Line	:	STE I
City	:	WINCHESTER
State	:	TN
Zip	:	37398-2495
Country	:	US
Telephone Number	:	931-968-9191
Fax Number	:	931-968-9081

Provider Business Practice Location Address
First Line	:	155 HOSPITAL RD
Second Line	:	STE I
City	:	WINCHESTER
State	:	TN
Zip	:	37398-2495
Country	:	US
Telephone Number	:	931-968-9191
Fax Number	:	931-968-9081

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	12/06/2007

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