Basic Information
| Provider Information | |||||||||
| NPI: | 1003948795 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PCL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5651 FRIST BLVD | ||||||||
| Address2: | SUITE 515 | ||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370762054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158893501 | ||||||||
| FaxNumber: | 6158893394 | ||||||||
| Practice Location | |||||||||
| Address1: | 5651 FRIST BLVD | ||||||||
| Address2: | SUITE 515 | ||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370762054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158893501 | ||||||||
| FaxNumber: | 6158893394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 10/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | FROMKIN | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
| AuthorizedOfficialMiddleName: | GRACE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 7064943071 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | TN | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207X00000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.