Provider Demographics
NPI:1386739142
Name:AMERICAN ORTHOPEDICS AND SPORTS MEDICINE, PLC
Entity type:Organization
Organization Name:AMERICAN ORTHOPEDICS AND SPORTS MEDICINE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-325-1215
Mailing Address - Street 1:105 REDBUD DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-1673
Mailing Address - Country:US
Mailing Address - Phone:615-325-1215
Mailing Address - Fax:615-860-7944
Practice Address - Street 1:105 REDBUD DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1673
Practice Address - Country:US
Practice Address - Phone:615-325-1215
Practice Address - Fax:615-860-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38266332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies