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General NPI Number Information
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NPI Number | 1023197605
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Entity Type | Organization
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Legal Business Name | BRISTOL ORTHOPAEDIC ASSOCIATES, P. C.
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 320 BRISTOL WEST BLVD SUITE 2A
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City | BRISTOL
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State | TN
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Zip | 37620-8765
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Country | US
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Telephone | 423-844-6414
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Fax | 423-968-1724
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Provider Business Mailing Address
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Address Line | 320 BRISTOL WEST BLVD SUITE 2A
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City | BRISTOL
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State | TN
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Zip | 37620-8765
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Country | US
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Telephone | 423-844-6414
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Fax | 423-968-1724
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM A MCILWAIN
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Credential | M.D.
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Telephone | 423-844-6414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD0000008779
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License Number State | TN
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