Provider Demographics
NPI:1902582216
Name:FOOT AND ANKLE SPECIALISTS OF TENNESSEE PLLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS OF TENNESSEE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-847-5219
Mailing Address - Street 1:8870 CEDAR SPRINGS LN STE 104
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5407
Mailing Address - Country:US
Mailing Address - Phone:865-686-8486
Mailing Address - Fax:
Practice Address - Street 1:8870 CEDAR SPRINGS LN STE 104
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5407
Practice Address - Country:US
Practice Address - Phone:865-686-8486
Practice Address - Fax:865-686-8486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty