Healthcare Provider Details

I. General information

NPI: 1821325424
Provider Name (Legal Business Name): WEST TENNESSEE ORTHOPAEDICS AND SPORTS MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 E REELFOOT AVE. SUITE 4
UNION CITY TN
38261-5871
US

IV. Provider business mailing address

1003 E REELFOOT AVE. SUITE 4
UNION CITY TN
38261-5871
US

V. Phone/Fax

Practice location:
  • Phone: 731-599-9766
  • Fax: 731-599-9887
Mailing address:
  • Phone: 731-599-9766
  • Fax: 731-599-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1368
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number1368
License Number StateTN

VIII. Authorized Official

Name: LAURENCE WILLIAMSON SCHWARTZ
Title or Position: PRESIDENT/PROVIDER
Credential: DO
Phone: 731-599-9766