MEDICARE: MCMINNVILLE ORTHOPAEDIC CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BC3200X	Customized Equipment (DME)
3	335E00000X	Prosthetic/Orthotic Supplier
4	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306809199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCMINNVILLE ORTHOPAEDIC CLINIC

Provider Business Mailing Address
First Line	:	207 OAK PARK
Second Line	:
City	:	MC MINNVILLE
State	:	TN
Zip	:	37110-1336
Country	:	US
Telephone Number	:	931-473-9624
Fax Number	:	931-473-7718

Provider Business Practice Location Address
First Line	:	1215 OLD MAIN ST
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-1619
Country	:	US
Telephone Number	:	270-730-5344
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DOUGLAS BRANDT HAYNES
Credential	:	M.D.
Telephone Number	:	931-473-9624

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	05/26/2021

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Directions to “MCMINNVILLE ORTHOPAEDIC CLINIC ” Practice Location

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