Healthcare Provider Details

I. General information

NPI: 1003948795
Provider Name (Legal Business Name): PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PCL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 FRIST BLVD SUITE 515
HERMITAGE TN
37076-2054
US

IV. Provider business mailing address

5651 FRIST BLVD SUITE 515
HERMITAGE TN
37076-2054
US

V. Phone/Fax

Practice location:
  • Phone: 615-889-3501
  • Fax: 615-889-3394
Mailing address:
  • Phone: 615-889-3501
  • Fax: 615-889-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateTN

VIII. Authorized Official

Name: AMANDA GRACE FROMKIN
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 706-494-3071