Provider Demographics
NPI:1306809199
Name:MCMINNVILLE ORTHOPAEDIC CLINIC
Entity type:Organization
Organization Name:MCMINNVILLE ORTHOPAEDIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:BRANDT
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-473-9624
Mailing Address - Street 1:207 OAK PARK
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1336
Mailing Address - Country:US
Mailing Address - Phone:931-473-9624
Mailing Address - Fax:931-473-7718
Practice Address - Street 1:1215 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1619
Practice Address - Country:US
Practice Address - Phone:270-730-5344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3191762Medicaid
TN3812480Medicaid
TN3384004Medicaid
TN3812480Medicaid
TN3812481Medicare ID - Type UnspecifiedIND # DONALD M ARMS
TN3384004Medicare ID - Type UnspecifiedGROUP ID#
TN3191762Medicare ID - Type UnspecifiedIND MC # DOUGLAS B HAYNES
TN3384004Medicaid
TNG52314Medicare UPIN