Provider Demographics
NPI:1700834579
Name:LAWRENCEBURG ORTHOPAEDICS, PC
Entity type:Organization
Organization Name:LAWRENCEBURG ORTHOPAEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CORNELIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-766-9996
Mailing Address - Street 1:PO BOX 1054
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-1054
Mailing Address - Country:US
Mailing Address - Phone:931-766-9996
Mailing Address - Fax:931-766-0955
Practice Address - Street 1:1323 S LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4040
Practice Address - Country:US
Practice Address - Phone:931-766-9996
Practice Address - Fax:931-766-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4151861Medicare ID - Type Unspecified
TNH94494Medicare UPIN