Provider Demographics
NPI:1659147056
Name:TENNESSEE ORTHOPAEDIC ALLIANCE PA
Entity Type:Organization
Organization Name:TENNESSEE ORTHOPAEDIC ALLIANCE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:AIUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-314-8114
Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8131 SAWYER BROWN RD STE 503
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:TN
Practice Address - Zip Code:37221-1430
Practice Address - Country:US
Practice Address - Phone:615-267-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3372041Medicaid