Healthcare Provider Details

I. General information

NPI: 1588291694
Provider Name (Legal Business Name): TENNESSEE ORTHOPAEDIC ALLIANCE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2639 TOPSIDE RD
LOUISVILLE TN
37777-3940
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: 865-692-2352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

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