Oliver, Russell Wade

Oliver, Russell Wade is an individual health care provider with primary practice located at 635 N. Main Street Suite A, Shelbyville TN 37160-3235. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot Surgery, which is considered as his primary health care specialty. Oliver, Russell Wade can be contacted via phone (931) 684-8884.

Contact Information

Primary practice address
635 N. Main Street Suite A Shelbyville TN 37160-3235
Phone: (931) 684-8884
Fax: (931) 684-8808
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X DPM0000000524 Tennessee

Profile Details

NPI number 1417095571
LBN Legal business name Oliver, Russell Wade
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 1st, 2007
Last updated Dec 15th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417095571 NPPES
Tennessee Other 3157415 BLUE CROSS BLUE SHIELD
Tennessee Other 480025490 BLUE CROSS BLUE SHIELD
Tennessee Other TN0101 BLUE CROSS BLUE SHIELD
Tennessee MEDICAID 1454420 BLUE CROSS BLUE SHIELD

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