1881889897 NPI number — HENRY COUNTY ORTHOPAEDIC SURGERY & SPORTS MEDICINE, PC

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 1881889897 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:
1881889897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2008
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:
161 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC KENZIE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38201-1636
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:
09/12/2007

Additional Information

			
		

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0188163 . This is a "BCBS" 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: 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: CG3049 . This is a "PALMETO GBA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".