Provider Demographics
NPI:1457445801
Name:TENNESSEE SPINE AND JOINT CENTER, P.C.
Entity Type:Organization
Organization Name:TENNESSEE SPINE AND JOINT CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-298-3205
Mailing Address - Street 1:2011 MURPHY AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2023
Mailing Address - Country:US
Mailing Address - Phone:615-298-3205
Mailing Address - Fax:615-298-3205
Practice Address - Street 1:2011 MURPHY AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2023
Practice Address - Country:US
Practice Address - Phone:615-298-3205
Practice Address - Fax:615-298-3283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4111112OtherBCBS
TN1891790010OtherINDIVIDUAL NPI NUMBER
TN1669445813OtherINDIVIDUAL NPI NUMBER
TN3159657OtherBCBS
TN3159657OtherBCBS
TN4111112OtherBCBS
TNA66442Medicare UPIN
TNI46379Medicare UPIN
TN3334247Medicare ID - Type Unspecified