Provider Demographics
NPI:1629491295
Name:OSTEOPATHIC CENTER
Entity Type:Organization
Organization Name:OSTEOPATHIC CENTER
Other - Org Name:KRISTOPHER GODDARD
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONTROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-693-8772
Mailing Address - Street 1:4801 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3839
Mailing Address - Country:US
Mailing Address - Phone:954-634-4292
Mailing Address - Fax:954-634-4293
Practice Address - Street 1:4320 BALL CAMP PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-3312
Practice Address - Country:US
Practice Address - Phone:865-693-8772
Practice Address - Fax:865-219-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-01
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000002081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty