Provider Demographics
NPI:1134328370
Name:ADVANCED ORTHOPEDICS & SPORTS MEDICINE, PLLC
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDICS & SPORTS MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CALFEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-885-8484
Mailing Address - Street 1:PO BOX 16765
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4062
Mailing Address - Country:US
Mailing Address - Phone:731-885-8484
Mailing Address - Fax:731-884-1609
Practice Address - Street 1:1720 E REELFOOT AVE
Practice Address - Street 2:STE 104
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6047
Practice Address - Country:US
Practice Address - Phone:731-885-8484
Practice Address - Fax:731-884-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34241207X00000X
TNMD30242208VP0000X
TN7562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370134OtherMEDICARE PTAN
TN6002450001Medicare NSC