Provider Demographics
NPI:1568409118
Name:TENNESSEE SPINE & SPORTS MEDECINE, P.C.
Entity Type:Organization
Organization Name:TENNESSEE SPINE & SPORTS MEDECINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-315-9002
Mailing Address - Street 1:397 WALLACE RD
Mailing Address - Street 2:STE 410
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4854
Mailing Address - Country:US
Mailing Address - Phone:615-315-9002
Mailing Address - Fax:
Practice Address - Street 1:397 WALLACE RD
Practice Address - Street 2:STE 410
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4854
Practice Address - Country:US
Practice Address - Phone:615-315-9002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000028032204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN200042899OtherRAILROAD MEDICARE
TN4454190001OtherMEDICARE DME
TN200042899OtherRAILROAD MEDICARE
TN4454190001OtherMEDICARE DME
TNG26811Medicare UPIN
TN3375837Medicare PIN