1124048541 NPI number — HENRY COUNTY ORTHOPAEDIC SURGERY & SPORTS MEDICINE,PC

Table of content: (NPI 1124048541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124048541 NPI number — HENRY COUNTY ORTHOPAEDIC SURGERY & SPORTS MEDICINE,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENRY COUNTY ORTHOPAEDIC SURGERY & SPORTS MEDICINE,PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124048541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 KELLEY DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38242-5819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-644-2271
Provider Business Mailing Address Fax Number:
731-644-3980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 KELLEY DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38242-5819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-644-2271
Provider Business Practice Location Address Fax Number:
731-644-3980
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TRIPLETT
Authorized Official First Name:
JEANETTTE
Authorized Official Middle Name:
Authorized Official Title or Position:
HR MANAGER
Authorized Official Telephone Number:
731-644-2271

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4090498 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1205833142 . This is a "GLADWELL NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1942279807 . This is a "SANDLIN NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0188163 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1346247186 . This is a "MCCABE SMITH NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4102404 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1164429080 . This is a "GULISH NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 200017654 . This is a "PALMETA GBA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: CG3049 . This is a "PALMETO GBA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00131527 . This is a "PALMETO GBA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3903155 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4291627 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 9002131747 . This is a "PALMETO GBA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1124048541 . This is a "GROUP NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1447574249 . This is a "VIRGINIA PEEBLES, FNP NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1521937 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3719301 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4058520 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4102410 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1194018622 . This is a "BARTON NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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