Provider Demographics
NPI:1770829053
Name:CARESPOT PROFESSIONAL SERVICES OF MIDDLE TENNESSEE LLC
Entity Type:Organization
Organization Name:CARESPOT PROFESSIONAL SERVICES OF MIDDLE TENNESSEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMIN OFFICER & GEN COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUNDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-600-4060
Mailing Address - Street 1:115 EAST PARK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2311
Mailing Address - Country:US
Mailing Address - Phone:615-600-4103
Mailing Address - Fax:615-309-4624
Practice Address - Street 1:115 EAST PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2311
Practice Address - Country:US
Practice Address - Phone:615-600-4103
Practice Address - Fax:615-309-4624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty