Provider Demographics
NPI:1922158047
Name:FIVE RIVERS ORTHOPAEDIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:FIVE RIVERS ORTHOPAEDIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-587-3487
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37815-0460
Mailing Address - Country:US
Mailing Address - Phone:423-587-3487
Mailing Address - Fax:423-586-7281
Practice Address - Street 1:231 S FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2036
Practice Address - Country:US
Practice Address - Phone:423-587-3487
Practice Address - Fax:423-586-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0224930001Medicare NSC
TN3382309Medicare PIN