Provider Demographics
NPI:1326132440
Name:ORTHOPAEDIC INSTITUTE OF CHATTANOOGA
Entity Type:Organization
Organization Name:ORTHOPAEDIC INSTITUTE OF CHATTANOOGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-624-6584
Mailing Address - Street 1:979 E 3RD ST
Mailing Address - Street 2:SUITE C430
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-624-6584
Mailing Address - Fax:423-624-6588
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE C430
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-624-6584
Practice Address - Fax:423-624-6588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376689Medicare ID - Type UnspecifiedMEDICARE GRP #
TN4582070001Medicare NSC