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General NPI Number Information
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NPI Number | 1083678098
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Entity Type | Organization
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Legal Business Name | RIVERGATE SPORTS MEDICINE AND ORTHOPAEDIC SURGERY, P.C.
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 353 NEW SHACKLE ISLAND RD SUITE 110A
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2379
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Country | US
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Telephone | 615-264-4785
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Fax | 615-264-4786
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Provider Business Mailing Address
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Address Line | 353 NEW SHACKLE ISLAND RD SUITE 110A
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2379
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Country | US
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Telephone | 615-264-4785
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Fax | 615-264-4786
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT PAUL LANDSBERG
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Credential | M.D.
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Telephone | 615-264-4785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD0000025005
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License Number State | TN
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