Provider Demographics
NPI:1801084884
Name:TENNESSEE VALLEY BONE AND JOINT LLC
Entity type:Organization
Organization Name:TENNESSEE VALLEY BONE AND JOINT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICKEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUTCHESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-476-5554
Mailing Address - Street 1:2350 N OCOEE ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3850
Mailing Address - Country:US
Mailing Address - Phone:423-476-5554
Mailing Address - Fax:423-614-6116
Practice Address - Street 1:2350 N OCOEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3850
Practice Address - Country:US
Practice Address - Phone:423-476-5554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370198Medicaid
TN3370198Medicare PIN