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General NPI Number Information
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NPI Number | 1891783981
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Entity Type | Organization
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Legal Business Name | SUMMIT BONE & JOINT, PLLC
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 03/02/2009
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Provider Practice Location Address
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Address Line | 5653 FRIST BLVD SUITE 731
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City | HERMITAGE
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State | TN
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Zip | 37076
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Country | US
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Telephone | 615-232-3838
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Fax | 615-232-3833
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Provider Business Mailing Address
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Address Line | P.O. BOX 306020
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City | NASHVILLE
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State | TN
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Zip | 37230-6020
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Country | US
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Telephone | 615-232-3838
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Fax | 615-232-3833
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | DR. MICHAEL S. LADOUCEUR
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Credential | MD
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Telephone | 615-232-3838
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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 | MD0000031901
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | MD0000031901
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License Number State | TN
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