MEDICARE: TULLAHOMA ORTHOPAEDICS & SPORTS MEDICINE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2085R0202X	Diagnostic Radiology Physician
2	208100000X	Physical Medicine & Rehabilitation Physician
3	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10070483	OTHER	TN	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	166220000	OTHER		US DEPT OF LABOR WORKER COMP
4	3093519	OTHER	TN	BLUE CROSS

General Provider Information

NPI Number	:	1306831417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TULLAHOMA ORTHOPAEDICS & SPORTS MEDICINE PLLC

Provider Business Mailing Address
First Line	:	1816 N WASHINGTON ST
Second Line	:	SUITE 100
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-2222
Country	:	US
Telephone Number	:	931-455-8676
Fax Number	:	931-455-9983

Provider Business Practice Location Address
First Line	:	1816 N WASHINGTON ST
Second Line	:	SUITE 100
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-2222
Country	:	US
Telephone Number	:	931-455-8676
Fax Number	:	931-455-9983

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. GARY R STEVENS
Credential	:	DO
Telephone Number	:	931-455-8676

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	04/13/2011

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Directions to “TULLAHOMA ORTHOPAEDICS & SPORTS MEDICINE PLLC ” Practice Location

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