Tackle Management Corporation

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

0103000741 Issued in VA

Legal business name

TACKLE MANAGEMENT CORPORATION

Doing business as

Bull Run Foot and Ankle Clinic Gainesville Foot and Ankle Clinic

Practice address

8637 Mathis Ave
Manassas, VA 20110-5270

Phone

(703) 368-1800

Fax

(703) 392-4820

NPI assigned

Apr 10, 2007

Organization subpart

Yes

Parent organization

TACKLE MANAGEMENT CORPORATIONAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Theresa Lynn Coates

Title

Practice Administrator

Phone

(703) 368-1800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bull Run Foot and Ankle Clinic Gainesville Foot and Ankle Clinic Doing business as

Part of

Tackle Management Corp

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Tackle Management Corporation

  dba Bull Run Foot Clinic

  • Foot & Ankle Surgery Podiatrist
  • Manassas, VA
  • NPI 1033399688
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Srikanth Mahavadi, DPM

  • Foot Surgery Podiatrist
  • Providence Forge, VA
  • NPI 1487610341
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217462400000",
    "number": "1831212067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8637 MATHIS AVE",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201105270",
            "telephone_number": "703-368-1800",
            "fax_number": "703-392-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8637 MATHIS AVE",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201105270",
            "telephone_number": "703-368-1800",
            "fax_number": "703-392-4820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TACKLE MANAGEMENT CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TACKLE MANAGEMENT CORPORATION",
        "enumeration_date": "2007-04-10",
        "last_updated": "2008-07-31",
        "status": "A",
        "authorized_official_last_name": "COATES",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "703-368-1800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "VA",
            "license": "0103000741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "C10314",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bull Run Foot and Ankle Clinic Gainesville Foot and Ankle Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rossana T Sy, MD
• Syamala K. Naroji MD PC
• Syamala K. Naroji MD PC
• Syncharmony Reh & Behavioral Care LLC (Syncharmony Rehab & Behavioral Care LLC)
• Tackle Management Corporation (Bull Run Foot Clinic)
• Hendeke Tafesse
• Njogho Tagyen
• Hamid Taheri, MD
• Chelsea Takyiwaah
• Talako Industries (Talako)

• Foot & Ankle Surgery Podiatrist in Manassas, VA
• Providers in Manassas, VA by specialty
• Foot & Ankle Surgery Podiatrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.