=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104315373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELITE PHYSICIANS GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2018
-----------------------------------------------------
Last Update Date | 05/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9005 OVERLOOK BLVD
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-5269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-873-2975
-----------------------------------------------------
Fax | 615-873-2975
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9005 OVERLOOK BLVD
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-5269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-873-2975
-----------------------------------------------------
Fax | 615-873-2975
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER/PARTNER
-----------------------------------------------------
Name | MR. CASEY WILLIAM SASSER
-----------------------------------------------------
Credential | N.P.
-----------------------------------------------------
Telephone | 931-206-3549
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 54921
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------