Provider Demographics
NPI:1235105255
Name:ORTHOPAEDIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-266-3719
Mailing Address - Street 1:979 E 3RD ST
Mailing Address - Street 2:STE C-220
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-3314
Mailing Address - Country:US
Mailing Address - Phone:423-267-4585
Mailing Address - Fax:423-756-1307
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:STE C-220
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-3314
Practice Address - Country:US
Practice Address - Phone:423-267-4585
Practice Address - Fax:423-756-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3151822Medicaid
TN3374205Medicaid
TN3871652Medicaid
TN3027228Medicaid
TN3826450Medicaid
TN3374205Medicaid
TN3027228Medicaid
TN3826450Medicare ID - Type UnspecifiedPHYSICIAN
TN3151823Medicare ID - Type UnspecifiedPHYSICIAN
TND45727Medicare UPIN
TNG75878Medicare UPIN
TNB03407Medicare UPIN
TN3093817Medicare ID - Type UnspecifiedPHYSICIAN
TN3151822Medicaid
TN3653643Medicare ID - Type UnspecifiedPT
TN3871652Medicaid
TN1004130001Medicare NSC
TN3871652Medicare ID - Type UnspecifiedPHYSICIAN
TN3170498Medicare ID - Type UnspecifiedPHYSICIAN
TN3826450Medicaid