1497976534 NPI number — TENNESSEE ORTHOPAEDIC CLINICS PC

Table of content: (NPI 1497976534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497976534 NPI number — TENNESSEE ORTHOPAEDIC CLINICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENNESSEE ORTHOPAEDIC CLINICS 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:
TENNESSEE ORTHOPAEDIC ALLIANCE
Provider Other Organization Name Type Code:
5
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:
1497976534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9129 CROSS PARK DR STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37923-4505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-694-7725
Provider Business Mailing Address Fax Number:
865-694-7907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1819 CLINCH AVE STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916-2435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-633-0259
Provider Business Practice Location Address Fax Number:
865-524-5047
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCONNELL
Authorized Official First Name:
ZENA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
865-694-0062

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  20611 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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