Provider Demographics
NPI:1336306117
Name:LAWRENCEBURG ORTHOPAEDICS AND SPORTS MEDICINE INSTITUTE PC
Entity Type:Organization
Organization Name:LAWRENCEBURG ORTHOPAEDICS AND SPORTS MEDICINE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LINDSEY
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-766-9996
Mailing Address - Street 1:1323 S LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4040
Mailing Address - Country:US
Mailing Address - Phone:931-766-9996
Mailing Address - Fax:931-766-0955
Practice Address - Street 1:1323 S LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4040
Practice Address - Country:US
Practice Address - Phone:931-766-9996
Practice Address - Fax:931-766-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43514207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
30014952OtherMEDICARE
TN1515083Medicaid