Provider Demographics
NPI:1063525236
Name:FORT SANDERS OBSTETRICAL AND GYNECOLOGICAL GROUP, P.C.
Entity type:Organization
Organization Name:FORT SANDERS OBSTETRICAL AND GYNECOLOGICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-524-3208
Mailing Address - Street 1:501 19TH STREET
Mailing Address - Street 2:SUITE 509
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1853
Mailing Address - Country:US
Mailing Address - Phone:865-524-3208
Mailing Address - Fax:865-522-4322
Practice Address - Street 1:501 19TH STREET
Practice Address - Street 2:SUITE 509
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1853
Practice Address - Country:US
Practice Address - Phone:865-524-3208
Practice Address - Fax:865-522-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3374388Medicare PIN