Provider Demographics
NPI:1043831498
Name:ELITE SPORTS MEDICINE AND ORTHOPAEDIC CENTER, PLC
Entity Type:Organization
Organization Name:ELITE SPORTS MEDICINE AND ORTHOPAEDIC CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:MCCLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-324-1600
Mailing Address - Street 1:2004 HAYES ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2689
Mailing Address - Country:US
Mailing Address - Phone:615-324-1600
Mailing Address - Fax:615-324-1661
Practice Address - Street 1:395 WALLACE RD STE 201A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4881
Practice Address - Country:US
Practice Address - Phone:615-324-1600
Practice Address - Fax:615-324-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty