Organization
MOMENTUM MEDICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENT VAN SICKLE MD (OWNER)
(615) 208-9010
Entity
Organization
Contact information
Practice address
1910 CHURCH ST, 2ND FLOOR (SUITE 200), NASHVILLE, TN 37203-2204
(615) 208-9010
(615) 208-9020
Mailing address
PO BOX 680245, FRANKLIN, TN 37068-0245
(615) 208-9010
(615) 208-9020
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1523117
—
TN
Enumeration date
12/15/2010
Last updated
04/02/2014
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