Provider Demographics
NPI:1659302685
Name:TRISTATE ORTHOPEDICS
Entity Type:Organization
Organization Name:TRISTATE ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-614-0097
Mailing Address - Street 1:2700 WESTSIDE DR NW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3699
Mailing Address - Country:US
Mailing Address - Phone:423-614-0097
Mailing Address - Fax:
Practice Address - Street 1:2700 WESTSIDE DR NW
Practice Address - Street 2:SUITE 103
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3699
Practice Address - Country:US
Practice Address - Phone:423-614-0097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709034Medicare ID - Type UnspecifiedMEDICARE GROUP ID#