Basic Information
| Provider Information | |||||||||
| NPI: | 1780270231 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENNESSEE ORTHOPAEDIC ALLIANCE PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TENNESSEE ORTHOPAEDIC CLINICS A DIVISION OF TOA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9118 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554809118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652438152 | ||||||||
| FaxNumber: | 8656922352 | ||||||||
| Practice Location | |||||||||
| Address1: | 576 FORT LOUDOUN MEDICAL CENTER DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | LENOIR CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377725676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659888667 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2020 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCCONNELL | ||||||||
| AuthorizedOfficialFirstName: | ZENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER OF CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 8652438152 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3372041 | 05 | TN | MEDICAID |