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General NPI Number Information
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NPI Number | 1295879054
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Entity Type | Organization
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Legal Business Name | MIDDLE TENNESSEE ORTHOPAEDICS, PC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 353 NEW SHACKLE ISLAND RD STE 226B
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2386
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Country | US
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Telephone | 615-264-2600
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Fax | 615-590-0065
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Provider Business Mailing Address
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Address Line | 353 NEW SHACKLE ISLAND RD STE 226B
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2386
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Country | US
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Telephone | 615-264-2600
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Fax | 615-590-0065
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT PAUL FOGOLIN
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Credential | MD
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Telephone | 615-264-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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