Healthcare Provider Details

I. General information

NPI: 1134328370
Provider Name (Legal Business Name): ADVANCED ORTHOPEDICS & SPORTS MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E REELFOOT AVE STE 104
UNION CITY TN
38261-6047
US

IV. Provider business mailing address

PO BOX 16765
BELFAST ME
04915-4062
US

V. Phone/Fax

Practice location:
  • Phone: 731-885-8484
  • Fax: 731-884-1609
Mailing address:
  • Phone: 731-885-8484
  • Fax: 731-884-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD34241
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD30242
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7562
License Number StateTN

VIII. Authorized Official

Name: DR. MICHAEL D CALFEE
Title or Position: MEMBER MANAGER
Credential: MD
Phone: 731-885-8484