Healthcare Provider Details

I. General information

NPI: 1659302685
Provider Name (Legal Business Name): TRISTATE ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WESTSIDE DR NW SUITE 103
CLEVELAND TN
37312-3699
US

IV. Provider business mailing address

2700 WESTSIDE DR NW SUITE 103
CLEVELAND TN
37312-3699
US

V. Phone/Fax

Practice location:
  • Phone: 423-614-0097
  • Fax:
Mailing address:
  • Phone: 423-614-0097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE RAPER
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 423-614-0097