Healthcare Provider Details

I. General information

NPI: 1891783981
Provider Name (Legal Business Name): SUMMIT BONE & JOINT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5653 FRIST BLVD SUITE 731
HERMITAGE TN
37076
US

IV. Provider business mailing address

P.O. BOX 306020
NASHVILLE TN
37230-6020
US

V. Phone/Fax

Practice location:
  • Phone: 615-232-3838
  • Fax: 615-232-3833
Mailing address:
  • Phone: 615-232-3838
  • Fax: 615-232-3833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD0000031901
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD0000031901
License Number StateTN

VIII. Authorized Official

Name: DR. MICHAEL S. LADOUCEUR
Title or Position: GENERAL MANAGER
Credential: MD
Phone: 615-232-3838