Provider Demographics
NPI:1932528338
Name:ECHELON SPORTS MEDICINE, PLLC
Entity Type:Organization
Organization Name:ECHELON SPORTS MEDICINE, PLLC
Other - Org Name:PROVISION SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:865-309-5551
Mailing Address - Street 1:510 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6643
Mailing Address - Country:US
Mailing Address - Phone:865-309-5551
Mailing Address - Fax:865-381-1967
Practice Address - Street 1:1400 DOWELL SPRINGS BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2456
Practice Address - Country:US
Practice Address - Phone:865-232-1408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2248261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty