Basic Information
| Provider Information | |||||||||
| NPI: | 1780965335 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENNESSEE ORTHOPAEDIC ALLIANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9118 | ||||||||
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| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554809118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153832693 | ||||||||
| FaxNumber: | 6156951483 | ||||||||
| Practice Location | |||||||||
| Address1: | 1623 NASHVILLE ST | ||||||||
| Address2: | STE 104 | ||||||||
| City: | RUSSELLVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422768889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002643762 | ||||||||
| FaxNumber: | 2707254801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2011 | ||||||||
| LastUpdateDate: | 09/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | WADE | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | EXEC DIR | ||||||||
| AuthorizedOfficialTelephone: | 6153296600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.