Provider Demographics
NPI:1225306533
Name:ORTHOTENNESSEE, PC
Entity Type:Organization
Organization Name:ORTHOTENNESSEE, PC
Other - Org Name:ORTHOPAEDIC SURGEONS OF OAK RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON-DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-769-4545
Mailing Address - Street 1:1855 TANNER WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8302
Mailing Address - Country:US
Mailing Address - Phone:865-376-2775
Mailing Address - Fax:
Practice Address - Street 1:1855 TANNER WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8302
Practice Address - Country:US
Practice Address - Phone:865-376-2775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4538070011Medicare PIN