Healthcare Provider Details

I. General information

NPI: 1831312461
Provider Name (Legal Business Name): WEST TENNESSEE BONE AND JOINT CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 01/06/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CAPITAL AVE
JACKSON TN
38305-2085
US

IV. Provider business mailing address

50 CAPITAL AVE
JACKSON TN
38305-2070
US

V. Phone/Fax

Practice location:
  • Phone: 731-410-2308
  • Fax: 731-668-6757
Mailing address:
  • Phone: 731-661-9825
  • Fax: 731-668-6757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD08163
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0369490001
License Number StateTN

VIII. Authorized Official

Name: JASON T HUTCHISON
Title or Position: PRESIDENT
Credential:
Phone: 731-661-9825