Provider Demographics
NPI:1538337910
Name:TENNESSEE BONE & JOINT CLINIC, PC
Entity type:Organization
Organization Name:TENNESSEE BONE & JOINT CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-215-6100
Mailing Address - Street 1:527A W MAIN ST
Mailing Address - Street 2:PO BOX 777
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-1137
Mailing Address - Country:US
Mailing Address - Phone:615-215-6100
Mailing Address - Fax:615-215-6180
Practice Address - Street 1:527A W MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-1137
Practice Address - Country:US
Practice Address - Phone:615-215-6100
Practice Address - Fax:615-215-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000030830174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3829715Medicaid
1699878694OtherNPI FOR SOLE PROVIDER
TN3829715Medicaid
1699878694OtherNPI FOR SOLE PROVIDER