1649713322 NPI number — ELITE SPORTS MEDICINE AND ORTHOPAEDIC CENTER, PLC

Table of content: (NPI 1649713322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649713322 NPI number — ELITE SPORTS MEDICINE AND ORTHOPAEDIC CENTER, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE SPORTS MEDICINE AND ORTHOPAEDIC CENTER, PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649713322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 896172
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28289-6172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-324-1600
Provider Business Mailing Address Fax Number:
615-284-2003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 WOODMONT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37215-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-324-1600
Provider Business Practice Location Address Fax Number:
615-284-2003
Provider Enumeration Date:
11/29/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCLOUD
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
615-324-1686

Provider Taxonomy Codes

  • Taxonomy code: 207QS0010X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0004X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)