Provider Demographics
NPI:1366868747
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:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:615-284-2000
Mailing Address - Street 1:2004 HAYES ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2646
Mailing Address - Country:US
Mailing Address - Phone:615-284-2000
Mailing Address - Fax:615-284-2003
Practice Address - Street 1:1616 W MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3100
Practice Address - Country:US
Practice Address - Phone:615-284-2000
Practice Address - Fax:615-284-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732025OtherGROUP MEDICARE NUMBER