Provider Demographics
NPI:1518164235
Name:FAMILY ORTHOPEDIC CLINIC PLLC
Entity Type:Organization
Organization Name:FAMILY ORTHOPEDIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MACNAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-218-7480
Mailing Address - Street 1:10810 PARKSIDE DRIVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1980
Mailing Address - Country:US
Mailing Address - Phone:865-218-7480
Mailing Address - Fax:865-218-7488
Practice Address - Street 1:10810 PARKSIDE DRIVE
Practice Address - Street 2:SUITE 109
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1980
Practice Address - Country:US
Practice Address - Phone:865-218-7480
Practice Address - Fax:865-218-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3069679Medicaid
TNF33167Medicare UPIN
TN30696791Medicare PIN
TN6318370001Medicare NSC