Basic Information
| Provider Information | |||||||||
| NPI: | 1932335551 | ||||||||
| 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 | ||||||||
| TelephoneNumber: | 9312451920 | ||||||||
| FaxNumber: | 9312451929 | ||||||||
| Practice Location | |||||||||
| Address1: | 647 DUNLOP LN | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370405165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312451920 | ||||||||
| FaxNumber: | 9312451929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2009 | ||||||||
| LastUpdateDate: | 11/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9315527474 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M. D. | ||||||||
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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.