=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457982019
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARPETH ORTHO URGENT PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2020
-----------------------------------------------------
Last Update Date | 02/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 CROSSINGS CIR STE 101
-----------------------------------------------------
City | MOUNT JULIET
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37122-8591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-758-1010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5000 CROSSINGS CIR STE 101
-----------------------------------------------------
City | MOUNT JULIET
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37122-8591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-758-1010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REVENUE CYCLE MANAGER
-----------------------------------------------------
Name | LEIGH ANN DYE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-758-1010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081S0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------