Healthcare Provider Details

I. General information

NPI: 1124614581
Provider Name (Legal Business Name): TENNESSEE ORTHOPAEDIC ALLIANCE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 PARK WEST BLVD STE 235
KNOXVILLE TN
37923-4207
US

IV. Provider business mailing address

PO BOX 306556
NASHVILLE TN
37230-6556
US

V. Phone/Fax

Practice location:
  • Phone: 865-690-4861
  • Fax: 865-560-8551
Mailing address:
  • Phone: 865-243-8153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY MCSWAIN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 865-243-8183