Healthcare Provider Details

I. General information

NPI: 1801993316
Provider Name (Legal Business Name): MIDDLE TENNESSEE ORTHOPAEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STEAM PLANT RD STE 420
GALLATIN TN
37066-3032
US

IV. Provider business mailing address

353 NEW SHACKLE ISLAND RD STE 226B
HENDERSONVILLE TN
37075
US

V. Phone/Fax

Practice location:
  • Phone: 615-264-2600
  • Fax:
Mailing address:
  • Phone: 615-264-2600
  • Fax: 615-264-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD29374
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT P FOGOLIN
Title or Position: PRESIDENT
Credential: MD
Phone: 615-264-2600