Provider Demographics
NPI:1053530246
Name:ORTHOONE SPORTS MEDICINE & ORTHOPAEDICS, PLLC
Entity type:Organization
Organization Name:ORTHOONE SPORTS MEDICINE & ORTHOPAEDICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-861-9610
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38027-1866
Mailing Address - Country:US
Mailing Address - Phone:901-861-9610
Mailing Address - Fax:901-861-9611
Practice Address - Street 1:9085 E SANDIDGE CV
Practice Address - Street 2:SUITE 200
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3575
Practice Address - Country:US
Practice Address - Phone:662-890-2663
Practice Address - Fax:662-890-2681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13282207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty