Provider Demographics
NPI:1679804462
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:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAGACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-284-2000
Mailing Address - Street 1:2004 HAYES ST
Mailing Address - Street 2:STE 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 1:2004 HAYES ST STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2646
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:2010-01-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty