1811074859 NPI number — SURGICAL MONITORING SERVICES, LLC

Table of content: (NPI 1811074859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811074859 NPI number — SURGICAL MONITORING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL MONITORING SERVICES, LLC
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:
SURGICAL MONITORING SERVICES, INC
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:
1811074859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 MARYLAND FARMS STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-348-4565
Provider Business Mailing Address Fax Number:
615-345-5405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 MARYLAND FARMS STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRENTWOOD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37027-5780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-348-4565
Provider Business Practice Location Address Fax Number:
615-345-5405
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP, CFO & CRO
Authorized Official Telephone Number:
800-348-4565

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1811074859 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 313953 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 418219700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 432840700 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004265957 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1015358060001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200806520A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 507408003 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7135619 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 73883875 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: GP4366 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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