Healthcare Provider Details

I. General information

NPI: 1932528338
Provider Name (Legal Business Name): ECHELON SPORTS MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 DOWELL SPRINGS BLVD SUITE 140
KNOXVILLE TN
37909-2456
US

IV. Provider business mailing address

510 OAKHURST DR
KNOXVILLE TN
37919-6643
US

V. Phone/Fax

Practice location:
  • Phone: 865-232-1408
  • Fax:
Mailing address:
  • Phone: 865-309-5551
  • Fax: 865-381-1967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number2248
License Number StateTN

VIII. Authorized Official

Name: DR. KEVIN SPROUSE
Title or Position: OWNER
Credential: D.O.
Phone: 865-309-5551