Provider Demographics
NPI:1699969097
Name:NASHVILLE SPORTS MEDICINE AND ORTHOPAEDIC CENTER PC
Entity type:Organization
Organization Name:NASHVILLE SPORTS MEDICINE AND ORTHOPAEDIC CENTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:WHITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-760-0877
Mailing Address - Street 1:2004 HAYES ST STE 700
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5178
Mailing Address - Country:US
Mailing Address - Phone:615-284-5800
Mailing Address - Fax:615-284-5819
Practice Address - Street 1:2004 HAYES ST STE 700
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-5178
Practice Address - Country:US
Practice Address - Phone:615-284-5800
Practice Address - Fax:615-284-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17901207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
374061900OtherOWCP
TN4146164OtherBCBST
TN3376166Medicare PIN
374061900OtherOWCP
TNB59035Medicare UPIN