Organization
TACKLE MANAGEMENT CORPORATION
Active
Parent organization
TACKLE MANAGEMENT CORPORATION
Other names
Bull Run Foot and Ankle Clinic Gainesville Foot and Ankle Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
TACKLE MANAGEMENT CORPORATION
Authorized official
MRS. THERESA LYNN COATES (PRACTICE ADMINISTRATOR)
(703) 368-1800
Entity
Organization
Contact information
Practice address
8637 MATHIS AVE, MANASSAS, VA 20110-5270
(703) 368-1800
(703) 392-4820
Mailing address
8637 MATHIS AVE, MANASSAS, VA 20110-5270
(703) 368-1800
(703) 392-4820
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0103000741
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C10314
MEDICARE PTAN
—
Enumeration date
04/10/2007
Last updated
07/31/2008
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