Provider Demographics
NPI:1881889897
Name:HENRY COUNTY ORTHOPAEDIC SURGERY & SPORTS MEDICINE, PC
Entity type:Organization
Organization Name:HENRY COUNTY ORTHOPAEDIC SURGERY & SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR/ACCT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-644-2271
Mailing Address - Street 1:1015 KELLEY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5819
Mailing Address - Country:US
Mailing Address - Phone:731-644-2271
Mailing Address - Fax:731-644-3980
Practice Address - Street 1:161 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-1636
Practice Address - Country:US
Practice Address - Phone:731-644-2271
Practice Address - Fax:731-644-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0188163OtherBCBS
TNP00131527OtherPALMETO GBA
TN3719301Medicaid
TN4058520OtherBCBS
TNCG3049OtherPALMETO GBA
KY0945101Medicare PIN
TNCG3049OtherPALMETO GBA
TN4058520OtherBCBS
KY0945103Medicare PIN
TNP00131527OtherPALMETO GBA
TN3719301Medicaid