Healthcare Provider Details

I. General information

NPI: 1386686806
Provider Name (Legal Business Name): ELK RIVER PHYSICIANS GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HOSPITAL RD SUITE D
WINCHESTER TN
37398-2494
US

IV. Provider business mailing address

48 SUNRISE PARK
WINCHESTER TN
37398-2345
US

V. Phone/Fax

Practice location:
  • Phone: 931-967-8055
  • Fax:
Mailing address:
  • Phone: 931-968-6405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000011440
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0000030284
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD0000026408
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDO0000001192
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD0000037655
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD0000020791
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD0000011992
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD0000037542
License Number StateTN
# 9
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM0000000591
License Number StateTN

VIII. Authorized Official

Name: JANE BOYLE
Title or Position: CEO
Credential:
Phone: 931-968-6405