Healthcare Provider Details

I. General information

NPI: 1245707983
Provider Name (Legal Business Name): UPPPERLINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 FRIST BLVD STE 630A
HERMITAGE TN
37076-2054
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 450
NASHVILLE TN
37205-5202
US

V. Phone/Fax

Practice location:
  • Phone: 615-627-2205
  • Fax: 615-970-7118
Mailing address:
  • Phone: 615-627-2205
  • Fax: 615-970-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID THORPE
Title or Position: PRESIDENT
Credential:
Phone: 615-627-2205