Organization
COLLIERVILLE ORTHOPEDICS AND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEDE COKE (OFFICE MANAGER)
(901) 850-1150
Entity
Organization
Contact information
Practice address
472 W POPLAR AVE STE 200, COLLIERVILLE, TN 38017-2780
(901) 850-1150
(901) 850-1102
Mailing address
PO BOX 9616, BELFAST, ME 04915-9616
(901) 850-1150
(901) 850-1102
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
2251X0800X
Orthopedic Physical Therapist
1717
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03404737
—
MS
05
—
3711730
—
TN
01
—
CK8118
RAILROAD MEDICARE
—
Enumeration date
06/05/2006
Last updated
11/01/2017
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