1548347396 NPI number — ORTHOPAEDIC CENTER OF GREENEVILLE

Table of content: (NPI 1548347396)

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:  1736 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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" .

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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