1548347396 NPI number — ORTHOPAEDIC CENTER OF GREENEVILLE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548347396 NPI number — ORTHOPAEDIC CENTER OF GREENEVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIC CENTER OF GREENEVILLE
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:
1548347396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1406 TUSCULUM BLVD
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
GREENEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37745-4341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-787-0767
Provider Business Mailing Address Fax Number:
423-787-0243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1406 TUSCULUM BLVD
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
GREENEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37745-4341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-787-0767
Provider Business Practice Location Address Fax Number:
423-787-0243
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
ANGIE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
423-787-0767

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  25711 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 1736 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4036256 . This is a "BCBS MICHAEL J MENZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1891776068 . This is a "NPI DONALD M SANDERCOCK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3378742 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4120705 . This is a "BCBS DONALD M SANDERCOCK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25711 . This is a "MICHAEL J MENZ MEDICAL LI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1598879991 . This is a "NPI MICHAEL J MENZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1736 . This is a "MEDICAL LICENSE DONALD M" identifier . This identifiers is of the category "OTHER".
  • Identifier: F84775 . This is a "DR MICHAEL J MENZ" identifier . This identifiers is of the category "OTHER".




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