MEDICARE: WEST TENNESSEE ORTHOPEDICS AND SPORTS MEDICINE,P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	26655	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043240716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST TENNESSEE ORTHOPEDICS AND SPORTS MEDICINE,P.C.

Provider Business Mailing Address
First Line	:	569 SKYLINE DR
Second Line	:	SUITE 100
City	:	JACKSON
State	:	TN
Zip	:	38301-3911
Country	:	US
Telephone Number	:	731-427-7888
Fax Number	:	731-265-4152

Provider Business Practice Location Address
First Line	:	569 SKYLINE DR
Second Line	:	SUITE 100
City	:	JACKSON
State	:	TN
Zip	:	38301-3911
Country	:	US
Telephone Number	:	731-427-7888
Fax Number	:	731-265-4152

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. KAY JORDAN
Credential	:
Telephone Number	:	731-427-7888

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	01/05/2011

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