Basic Information
| Provider Information | |||||||||
| NPI: | 1245660869 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GATEWAY FOOT AND ANKLE CENTER, PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 647 DUNLOP LN | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370405165 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 313 N MAIN ST. | ||||||||
| Address2: | SUITE 1J | ||||||||
| City: | ASHLAND CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370151347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312451920 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2013 | ||||||||
| LastUpdateDate: | 11/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9312451920 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GATEWAY FOOT AND ANKLE CENTER, PLC | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.