Provider Demographics
NPI:1154365104
Name:TENNESSEE SPORTS MEDICINE & ORTHOPAEDICS, PC
Entity type:Organization
Organization Name:TENNESSEE SPORTS MEDICINE & ORTHOPAEDICS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KAELIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:615-553-5500
Mailing Address - Street 1:5002 CROSSING CIRCLE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MT. JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8471
Mailing Address - Country:US
Mailing Address - Phone:615-553-5500
Mailing Address - Fax:615-553-5501
Practice Address - Street 1:5002 CROSSING CIRCLE
Practice Address - Street 2:SUITE 200
Practice Address - City:MT. JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8471
Practice Address - Country:US
Practice Address - Phone:615-553-5500
Practice Address - Fax:615-553-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25086174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5022730001Medicare NSC
3723564Medicare ID - Type Unspecified