Basic Information
Provider Information
NPI: 1821321803
EntityType: 2
ReplacementNPI:  
OrganizationName: GENERAL ORTHOPAEDICS, PA
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 310
Address2:  
City: MOUNTAIN HOME
State: AR
PostalCode: 726540310
CountryCode: US
TelephoneNumber: 8704245079
FaxNumber: 8704248455
Practice Location
Address1: 310 BUTTERCUP DR STE A
Address2:  
City: MOUNTAIN HOME
State: AR
PostalCode: 726532932
CountryCode: US
TelephoneNumber: 8704243642
FaxNumber: 8704243712
Other Information
ProviderEnumerationDate: 09/09/2009
LastUpdateDate: 09/09/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: GREEN
AuthorizedOfficialFirstName: TERRY
AuthorizedOfficialMiddleName: G
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 8704243642
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000XC4667ARY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


Home