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General NPI Number Information
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NPI Number | 1497957237
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Entity Type | Organization
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Legal Business Name | LINCOLN MEDICAL CENTER ORTHOPEDIC CLINIC
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 108 MEDICAL CENTER BLVD STE 175
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-2741
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Country | US
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Telephone | 931-438-1100
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Fax | 931-438-7491
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Provider Business Mailing Address
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Address Line | 106 MEDICAL CENTER BLVD LINCOLN MEDICAL CENTER
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-2684
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Country | US
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Telephone | 931-438-1100
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Fax | 931-438-1100
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARK DWIGHT NORDYKE
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Credential | MD
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Telephone | 931-438-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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