Provider Demographics
NPI:1235158486
Name:SOUTHERN ORTHOPAEDIC FOOT & ANKLE CTR
Entity Type:Organization
Organization Name:SOUTHERN ORTHOPAEDIC FOOT & ANKLE CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-622-3668
Mailing Address - Street 1:725 GLENWOOD DR
Mailing Address - Street 2:STE E884
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1182
Mailing Address - Country:US
Mailing Address - Phone:423-622-3668
Mailing Address - Fax:423-622-3676
Practice Address - Street 1:725 GLENWOOD DR
Practice Address - Street 2:STE E884
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1182
Practice Address - Country:US
Practice Address - Phone:423-622-3668
Practice Address - Fax:423-622-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD009321207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA99040Medicare UPIN
TN0728140001Medicare NSC
TN3026531Medicare PIN