Organization
OLIVER FOOT CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL WADE OLIVER DPM (OWNER/PRESIDENT)
(931) 684-8884
Entity
Organization
Contact information
Practice address
635 N. MAIN STREET, SUITE A, SHELBYVILLE, TN 37160-3235
(931) 684-8884
(931) 684-8808
Mailing address
P.O. BOX 766, SHELBYVILLE, TN 37162-0766
(931) 684-8884
(931) 684-8808
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
DPM0000000524
TN
213ES0131X
Foot Surgery Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454420
—
TN
01
—
3157415
BLUE CROSS BLUE SHIELD
TN
01
—
480025490
MEDICARE RAILROAD
TN
01
—
TN0101
AMERICHOICE
TN
Enumeration date
02/01/2007
Last updated
12/29/2009
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