Provider Demographics
NPI:1750560132
Name:ORTHOTENNESSEE, PC
Entity type:Organization
Organization Name:ORTHOTENNESSEE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON-DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-769-4545
Mailing Address - Street 1:90 VERMONT AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6474
Mailing Address - Country:US
Mailing Address - Phone:865-482-2390
Mailing Address - Fax:865-482-2347
Practice Address - Street 1:90 VERMONT AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6474
Practice Address - Country:US
Practice Address - Phone:865-482-2390
Practice Address - Fax:865-482-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4538070011OtherSUPPLIER NUMBER