Provider Demographics
NPI:1497957237
Name:LINCOLN MEDICAL CENTER ORTHOPEDIC CLINIC
Entity Type:Organization
Organization Name:LINCOLN MEDICAL CENTER ORTHOPEDIC CLINIC
Other - Org Name:LINCOLN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:NORDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-438-1100
Mailing Address - Street 1:106 MEDICAL CENTER BLVD
Mailing Address - Street 2:LINCOLN MEDICAL CENTER
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2684
Mailing Address - Country:US
Mailing Address - Phone:931-438-1100
Mailing Address - Fax:931-438-1100
Practice Address - Street 1:108 MEDICAL CENTER BLVD
Practice Address - Street 2:STE 175
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2741
Practice Address - Country:US
Practice Address - Phone:931-438-1100
Practice Address - Fax:931-438-7491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherEIN