1720204449 NPI number — NASHVILLE NEUROSURGERY GROUP, PLC

Table of content: (NPI 1720204449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720204449 NPI number — NASHVILLE NEUROSURGERY GROUP, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NASHVILLE NEUROSURGERY GROUP, PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TENNESSEE BRAIN AND SPINE, PLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720204449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 22ND AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-1844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-320-0007
Provider Business Mailing Address Fax Number:
615-320-0009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 22ND AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-1844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-320-0007
Provider Business Practice Location Address Fax Number:
615-320-0009
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
615-320-0007

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 612478900 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3370096 . This is a "TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: DG4593 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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