Provider Demographics
NPI:1407951106
Name:HENRY COUNTY ORTHOPAEDIC SURGERY & SPORTS MEDICINE, INC
Entity Type:Organization
Organization Name:HENRY COUNTY ORTHOPAEDIC SURGERY & SPORTS MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR ACCT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-644-2271
Mailing Address - Street 1:1015 KELLEY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5819
Mailing Address - Country:US
Mailing Address - Phone:731-644-2271
Mailing Address - Fax:731-644-3980
Practice Address - Street 1:701 E REELFOOT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5880
Practice Address - Country:US
Practice Address - Phone:800-726-6379
Practice Address - Fax:731-644-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4058520OtherBCBS
KY000000353340OtherBCBS
TN143389OtherUNISON
KY64082274Medicaid
TN553436344OtherTRICARE
TN3719301Medicaid
TNP00131527OtherPALMETO GBA
KY0945103Medicare PIN
TN3719301Medicare ID - Type UnspecifiedGROUP
TNP00131527OtherPALMETO GBA
TN3881222Medicare ID - Type UnspecifiedHEATHER GLADWELL,MD
TN3719301Medicaid