# RENUVA XTREMITY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205305430
- **Authorized official:** MR. NATHAN LUCAS JR. DPM (PODIATRIST)
- **Authorized official phone:** (901) 309-8898

## Contact information

- **Practice address:** 2900 KIRBY PKWY, STE 5, MEMPHIS, TN 38119
- **Practice address phone:** (901) 309-8898
- **Practice address fax:** (901) 309-5908
- **Mailing address:** 2900 KIRBY PKWY, STE 5, MEMPHIS, TN 38119
- **Mailing address phone:** (901) 309-8898
- **Mailing address fax:** (901) 309-5908

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |
| 291U00000X | Clinical Medical Laboratory | — | NULL | — |
| 293D00000X | Physiological Laboratory | — | NULL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | — |

## Other

- **Enumeration date:** 11/16/2018
- **Last updated:** 04/14/2020