Provider Demographics
NPI:1134354749
Name:FAMILY ORTHOPEDIC CLINIC, PLLC
Entity type:Organization
Organization Name:FAMILY ORTHOPEDIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MACNAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-218-7480
Mailing Address - Street 1:10810 PARKSIDE DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1979
Mailing Address - Country:US
Mailing Address - Phone:865-218-7480
Mailing Address - Fax:865-218-7488
Practice Address - Street 1:10810 PARKSIDE DR
Practice Address - Street 2:STE 109
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1979
Practice Address - Country:US
Practice Address - Phone:865-218-7480
Practice Address - Fax:865-218-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514945Medicaid
TN3373632Medicare PIN
TN1514945Medicaid