Organization
MARYVILLE FOOT CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRANDI C HEGERTY (OFFICE MANAGER)
(865) 681-6667
Entity
Organization
Contact information
Practice address
1515 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5131
(865) 982-2119
(865) 984-5642
Mailing address
1515 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5131
(865) 982-2119
(865) 984-5642
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
564
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1231208
CIGNA
TN
05
—
3732878
—
TN
01
—
4118088
BCBS OF TN
TN
01
—
7404093
AETNA
TN
01
—
BNA2743006
UNITED HEALTHCARE
TN
01
—
TN0101
JOHN DEERE
TN
Enumeration date
07/25/2006
Last updated
04/20/2008
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