Provider Demographics
NPI:1548571482
Name:TENNESSEE SPORTS MEDICINE, PC
Entity type:Organization
Organization Name:TENNESSEE SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPAEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KAELIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:615-553-5000
Mailing Address - Street 1:4998 CROSSINGS CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-0018
Mailing Address - Country:US
Mailing Address - Phone:615-553-5000
Mailing Address - Fax:615-758-3875
Practice Address - Street 1:4998 CROSSINGS CIR STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-0018
Practice Address - Country:US
Practice Address - Phone:615-553-5000
Practice Address - Fax:615-758-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN025086207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520487Medicaid
3723564OtherMEDICARE ID
TN103G703406Medicare PIN