# SPORT ORTHO URGENT CARE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659750834
- **Authorized official:** DR. CHARLES R. KAELIN JR. M.D. (OWNER)
- **Authorized official phone:** (615) 553-5000

## Contact information

- **Practice address:** 4998 CROSSINGS CIR STE 200, MOUNT JULIET, TN 37122-0018
- **Practice address phone:** (615) 553-5000
- **Practice address fax:** (615) 758-3875
- **Mailing address:** 4998 CROSSINGS CIR STE 200, MOUNT JULIET, TN 37122-0018
- **Mailing address phone:** (615) 553-5000
- **Mailing address fax:** (615) 758-3875

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | — | — |
| 261QU0200X | Urgent Care Clinic/Center | — | TN | Yes |

## Other

- **Enumeration date:** 05/21/2015
- **Last updated:** 07/15/2021