Organization
SUMMIT BONE & JOINT, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL S. LADOUCEUR MD (GENERAL MANAGER)
(615) 232-3838
Entity
Organization
Contact information
Practice address
5653 FRIST BLVD, SUITE 731, HERMITAGE, TN 37076
(615) 232-3838
(615) 232-3833
Mailing address
P.O. BOX 306020, NASHVILLE, TN 37230-6020
(615) 232-3838
(615) 232-3833
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD0000031901
TN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
MD0000031901
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0516031005
CIGNA HMO-POS
TN
01
—
0516031006
CIGNA PPO
TN
01
—
0940372
UNITED HEALTHCARE
TN
05
—
1506501
—
TN
01
—
2000043639
RAILROAD MEDICARE
TN
01
—
2638088
AETNA HMO
TN
01
—
4023754
BCBS
TN
01
—
5282039
AETNA PPO
TN
Enumeration date
10/12/2005
Last updated
03/02/2009
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