Provider Demographics
NPI:1902428816
Name:TENNESSEE VALLEY ORTHOPAEDICS, LLC
Entity type:Organization
Organization Name:TENNESSEE VALLEY ORTHOPAEDICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:SORCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-475-5103
Mailing Address - Street 1:120 HOSPITAL DR STE G20
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-5284
Mailing Address - Country:US
Mailing Address - Phone:865-475-5103
Mailing Address - Fax:865-475-5106
Practice Address - Street 1:120 HOSPITAL DR STE G20
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-5284
Practice Address - Country:US
Practice Address - Phone:865-475-5103
Practice Address - Fax:865-475-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ046734Medicaid