Provider Demographics
NPI:1023087475
Name:EAST MEMPHIS ORTHOPEDIC GROUP
Entity type:Organization
Organization Name:EAST MEMPHIS ORTHOPEDIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOFFATT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:901-682-5642
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-682-5642
Mailing Address - Fax:901-683-5527
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-682-5642
Practice Address - Fax:901-683-5527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACD3780OtherRAILROAD MEDICARE
TN3373059Medicaid
TN0928140001Medicare NSC
TN3373059Medicare PIN