=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851988513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TENNESSEE ORTHOPAEDIC ALLIANCE PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2020
-----------------------------------------------------
Last Update Date | 10/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 961 OAK RIDGE TPKE
-----------------------------------------------------
City | OAK RIDGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37830-8832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-483-1906
-----------------------------------------------------
Fax | 865-483-3807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 306556
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37230-6556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-243-8183
-----------------------------------------------------
Fax | 865-694-7907
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | ASHLEY MCSWAIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-243-8183
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------