Healthcare Provider Details

I. General information

NPI: 1669115622
Provider Name (Legal Business Name): ELITE SPORTS MEDICINE AND ORTHOPAEDIC CENTER, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 HEALTH PARK DR
BRENTWOOD TN
37027-5721
US

IV. Provider business mailing address

2004 HAYES ST STE 200
NASHVILLE TN
37203-2689
US

V. Phone/Fax

Practice location:
  • Phone: 615-324-1600
  • Fax: 615-324-1661
Mailing address:
  • Phone: 615-324-1600
  • Fax: 615-324-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA BROWN
Title or Position: DIRECTOR OF ADMINISTRATION
Credential:
Phone: 615-324-1600