Healthcare Provider Details

I. General information

NPI: 1477740512
Provider Name (Legal Business Name): TENNESSEE ORTHOPAEDIC CLINICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 OAK RIDGE TPKE
OAK RIDGE TN
37830-8832
US

IV. Provider business mailing address

PO BOX 32569
KNOXVILLE TN
37930-2569
US

V. Phone/Fax

Practice location:
  • Phone: 865-483-1906
  • Fax: 865-483-3807
Mailing address:
  • Phone: 865-694-0062
  • Fax: 865-694-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25901
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateTN

VIII. Authorized Official

Name: ZENA ANN MCCONNELL
Title or Position: CREDENTIALING
Credential:
Phone: 865-694-0062