Provider Demographics
NPI:1679664494
Name:ORTHOTENNESSEE, PC
Entity Type:Organization
Organization Name:ORTHOTENNESSEE, PC
Other - Org Name:UNIVERSITY ORTHOPEDIC SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON-DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-769-4545
Mailing Address - Street 1:1926 ALCOA HWY
Mailing Address - Street 2:BLDG F, SUITE 210
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1545
Mailing Address - Country:US
Mailing Address - Phone:865-546-2663
Mailing Address - Fax:865-546-9047
Practice Address - Street 1:11440 PARKSIDE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934
Practice Address - Country:US
Practice Address - Phone:865-218-9300
Practice Address - Fax:865-218-9339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3711675Medicare PIN
TN3711574Medicare PIN