Provider Demographics
NPI:1134670664
Name:TENNESSEE ORTHOPEDICS, PC
Entity Type:Organization
Organization Name:TENNESSEE ORTHOPEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR/MD
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:C
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-449-0990
Mailing Address - Street 1:556 HARTSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2491
Mailing Address - Country:US
Mailing Address - Phone:615-461-7335
Mailing Address - Fax:615-461-7418
Practice Address - Street 1:556 HARTSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2491
Practice Address - Country:US
Practice Address - Phone:615-461-7335
Practice Address - Fax:615-461-7418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3717761Medicaid
3717761Medicare PIN