Provider Demographics
NPI:1043568900
Name:PETERSON BONE AND JOINT INSTITUTE PC
Entity Type:Organization
Organization Name:PETERSON BONE AND JOINT INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-668-4585
Mailing Address - Street 1:3085 SPARTA ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1364
Mailing Address - Country:US
Mailing Address - Phone:931-815-2663
Mailing Address - Fax:931-815-2664
Practice Address - Street 1:1589 SPARTA ST
Practice Address - Street 2:SUITE 203A
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1390
Practice Address - Country:US
Practice Address - Phone:931-668-4585
Practice Address - Fax:931-668-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2130207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty