Provider Demographics
NPI:1942214598
Name:GRIFFIN ORTHOPEDICS & SPORTS
Entity Type:Organization
Organization Name:GRIFFIN ORTHOPEDICS & SPORTS
Other - Org Name:COMPLETE ORTHOPAEDIC & SPORTS MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:474-474-8005
Mailing Address - Street 1:2020 CHESTNUT ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5321
Mailing Address - Country:US
Mailing Address - Phone:479-474-8005
Mailing Address - Fax:479-474-4073
Practice Address - Street 1:2020 CHESTNUT ST
Practice Address - Street 2:SUITE 107
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5321
Practice Address - Country:US
Practice Address - Phone:479-474-8005
Practice Address - Fax:479-474-4073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8118204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR200033120OtherRAILROAD MEDICARE