Provider Demographics
NPI:1336905561
Name:TENNESSEE ORTHOPAEDIC ALLIANCE
Entity Type:Organization
Organization Name:TENNESSEE ORTHOPAEDIC ALLIANCE
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:865-243-8183
Mailing Address - Fax:
Practice Address - Street 1:1000 SOUTH GATEWAY BLVD.
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-552-4340
Practice Address - Fax:931-552-0999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENNESSEE ORTHOPAEDIC ALLIANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty