Provider Demographics
NPI:1720073810
Name:UNIVERSITY ORTHOPEDIC CLINIC
Entity Type:Organization
Organization Name:UNIVERSITY ORTHOPEDIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:DEGNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-521-7662
Mailing Address - Street 1:501 19TH ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1854
Mailing Address - Country:US
Mailing Address - Phone:865-521-7662
Mailing Address - Fax:865-541-2895
Practice Address - Street 1:501 19TH ST
Practice Address - Street 2:SUITE 601
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1854
Practice Address - Country:US
Practice Address - Phone:865-521-7662
Practice Address - Fax:865-541-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD020653174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN166410400OtherU.S. DEPT. OF LABOR PROV.
TN21159366OtherWAUSAU PROVIDER #
TN121659OtherBLUE CROSS PROVIDER #
TN3052501Medicare PIN
TN121659OtherBLUE CROSS PROVIDER #
TN21159366OtherWAUSAU PROVIDER #