Provider Demographics
NPI:1760783104
Name:LINCOLN MEDICAL CENTER ORTHOPEDIC CLINIC
Entity Type:Organization
Organization Name:LINCOLN MEDICAL CENTER ORTHOPEDIC CLINIC
Other - Org Name:PREMIER ORTHOPEDIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:GROCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-438-1100
Mailing Address - Street 1:108 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2684
Mailing Address - Country:US
Mailing Address - Phone:931-433-1102
Mailing Address - Fax:931-433-0522
Practice Address - Street 1:108 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2684
Practice Address - Country:US
Practice Address - Phone:931-433-1102
Practice Address - Fax:931-433-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty