Basic Information
| Provider Information | |||||||||
| NPI: | 1669115622 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELITE SPORTS MEDICINE AND ORTHOPAEDIC CENTER, PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2004 HAYES ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153241600 | ||||||||
| FaxNumber: | 6153241661 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 HEALTH PARK DR | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153241600 | ||||||||
| FaxNumber: | 6153241661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2022 | ||||||||
| LastUpdateDate: | 04/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 6153241600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ELITE SPORTS MEDICINE AND ORTHOPAEDIC CENTER, PLC | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207XS0117X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XX0004X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | 207XX0005X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 363AS0400X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.