Bull Run Foot Clinic

LBN: Tackle Management Corporation
Bull Run Foot Clinic is an health care organization with primary practice located at 8637 Mathis Ave , Manassas VA 20110-5270. The organization recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as the primary health care specialty. Tackle Management Corporation can be contacted via phone (703) 335-6890, or through Coates, Theresa Lynn via phone (703) 368-1800.

Contact Information

Primary practice address
8637 Mathis Ave Manassas VA 20110-5270
Phone: (703) 335-6890
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Coates, Theresa Lynn
Phone: (703) 368-1800

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X Virginia

Profile Details

NPI number 1033399688
LBN Legal business name Tackle Management Corporation
DBA Doing business as Bull Run Foot Clinic
Authorized official Coates, Theresa Lynn
Entity Organization
Organization subpart 1 No
Enumeration date Nov 13th, 2007
Last updated Nov 13th, 2007 - about 19 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1033399688 NPPES
Virginia Other 296209 ANTHEM

Popular Providers