Provider Demographics
NPI:1346420924
Name:SUSAN N PICK
Entity Type:Organization
Organization Name:SUSAN N PICK
Other - Org Name:PLATEAU ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:PICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-707-8383
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557-0568
Mailing Address - Country:US
Mailing Address - Phone:931-707-8383
Mailing Address - Fax:931-707-1076
Practice Address - Street 1:493 LANTANA RD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4946
Practice Address - Country:US
Practice Address - Phone:931-707-8383
Practice Address - Fax:931-707-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN023765174400000X, 273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No273Y00000XHospital UnitsRehabilitation UnitGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN165713900OtherDEPT OF LABOR
1568572675OtherINDIVIUAL NPI
TN3279965OtherCIGNA
TN3716258Medicaid
TN1196780001OtherCIGNA GOVT SERVICES DME
TN3060722OtherBLUE CROSS BLUE SHIELD TN
TN1196780001OtherCIGNA GOVT SERVICES DME
TN165713900OtherDEPT OF LABOR
TN3716258Medicare PIN
1568572675OtherINDIVIUAL NPI