Healthcare Provider Details

I. General information

NPI: 1164923298
Provider Name (Legal Business Name): OPRY MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 DOMINICAN DR
NASHVILLE TN
37228-1906
US

IV. Provider business mailing address

810 DOMINICAN DR
NASHVILLE TN
37228-1906
US

V. Phone/Fax

Practice location:
  • Phone: 843-530-0541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateTN

VIII. Authorized Official

Name: JASON RIDGEL
Title or Position: OWNER / PRESIDENT
Credential:
Phone: 629-777-5252