Provider Demographics
NPI:1023197605
Name:BRISTOL ORTHOPAEDIC ASSOCIATES, P. C.
Entity Type:Organization
Organization Name:BRISTOL ORTHOPAEDIC ASSOCIATES, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCILWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-844-6414
Mailing Address - Street 1:320 BRISTOL WEST BLVD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-8765
Mailing Address - Country:US
Mailing Address - Phone:423-844-6414
Mailing Address - Fax:423-968-1724
Practice Address - Street 1:320 BRISTOL WEST BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-8765
Practice Address - Country:US
Practice Address - Phone:423-844-6414
Practice Address - Fax:423-968-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000008779207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3374030Medicare ID - Type Unspecified