Provider Demographics
NPI:1023064367
Name:ORTHOPAEDIC & SPORTS MEDICINE CLINIC PLLC
Entity type:Organization
Organization Name:ORTHOPAEDIC & SPORTS MEDICINE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-967-5860
Mailing Address - Street 1:144 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2402
Mailing Address - Country:US
Mailing Address - Phone:931-967-5860
Mailing Address - Fax:931-967-0776
Practice Address - Street 1:144 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2402
Practice Address - Country:US
Practice Address - Phone:931-967-5860
Practice Address - Fax:931-967-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD23831207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCI6855OtherRAILROAD MEDICARE GROUP
TN3711134Medicare ID - Type UnspecifiedGROUP NUMBER
TNCI6855OtherRAILROAD MEDICARE GROUP