NPIMap

Organization Active NPI

Mountainside Orthopedics

  • Durable Medical Equipment & Medical Supplies
  • Jasper, GA
National Provider Identifier
1639293988
Registry record updated Jan 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
035504 Issued in GA
Legal business name
MOUNTAINSIDE ORTHOPEDICS
Practice address
620 J L White Dr
Suite 100
Jasper, GA 30143-4896
Phone
(706) 692-6980
NPI assigned
Mar 19, 2007
Last updated
Jan 8, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Tardif
Title
Credentialing Manager
Phone
(770) 801-2526

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 035504 GA Primary

Addresses

Primary practice location

620 J L White Dr
Suite 100
Jasper, GA 30143-4896

Mailing address

PO Box 102321
Atlanta, GA 30368-2321

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231372800000",
    "number": "1639293988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102321",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 J L WHITE DR",
            "address_2": "SUITE 100",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "301434896",
            "telephone_number": "706-692-6980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINSIDE ORTHOPEDICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2009-01-08",
        "status": "A",
        "authorized_official_last_name": "TARDIF",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "770-801-2526"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "035504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasper, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.