Provider Demographics
NPI:1053690958
Name:FEET FIRST PODIATRY PC
Entity type:Organization
Organization Name:FEET FIRST PODIATRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:901-365-3668
Mailing Address - Street 1:7878 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2307
Mailing Address - Country:US
Mailing Address - Phone:901-365-3668
Mailing Address - Fax:
Practice Address - Street 1:1415 E REELFOOT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5812
Practice Address - Country:US
Practice Address - Phone:731-885-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN475213ES0103X
TN494213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3352246Medicare PIN
IL381750Medicare PIN
TN10370G7165Medicare UPIN
IL1891743241Medicare UPIN
TN103I487163Medicare UPIN
1235201898Medicare UPIN
ILU56776Medicare UPIN
TN3352245Medicare PIN
TN103I487161Medicare UPIN