Provider Demographics
NPI:1366617466
Name:CLARKSVILLE ORTHOPEDICS, PLC
Entity type:Organization
Organization Name:CLARKSVILLE ORTHOPEDICS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUNCAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCKELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:931-552-7474
Mailing Address - Street 1:311 LANDRUM PLACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:931-552-7474
Mailing Address - Fax:931-552-3616
Practice Address - Street 1:311 LANDRUM PLACE
Practice Address - Street 2:SUITE 100
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-552-7474
Practice Address - Fax:931-552-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20622207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3054153Medicaid