Basic Information
| Provider Information | |||||||||
| NPI: | 1487657169 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUGALSKI | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 5651 FRIST BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370762058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153914545 | ||||||||
| FaxNumber: | 6153914546 | ||||||||
| Practice Location | |||||||||
| Address1: | 5651 FRIST BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370762058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153914545 | ||||||||
| FaxNumber: | 6153914546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 46419 | MN | N | Other Service Providers | Specialist | 207X00000X | 219380 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 46419 | MN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD26225 | OR | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD13601 | HI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 53892 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 60594 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.