1679841738 NPI NUMBER - MUA OF MIDDLE TENNESSEE, LLC
Summary
|
|
|
|
|
NPI Number |
1679841738 |
| Entity Type Code |
Organization |
| Provider Legal Name |
MUA OF MIDDLE TENNESSEE, LLC |
| Provider Business Practice Location Address |
28 WHITE BRIDGE ROAD
SUITE 210
NASHVILLE, TN
ZIP 37205
|
| Practice Location Phone Number |
(615) 356-4690 |
| Provider Taxonomy Code |
261QA1903X - Clinic/Center |
| Specialization |
Ambulatory Surgical |
| Provider Enumeration Date |
12/5/2011 |
| Last Update Date |
9/7/2012 |
NPI Number 1679841738 is assigned to an organization registered under the healthcare provider name MUA OF MIDDLE TENNESSEE, LLC .
The provider is physically located at:
28 WHITE BRIDGE ROAD
SUITE 210
NASHVILLE, TN
ZIP 37205-499
Phone: (615) 356-4690
Fax: (615) 352-6673
The provider's authorized official is DEANNA FAYE SMITH .
The authorized official title is PRACTICE ADMINISTRATOR and has the following contact phone number (615) 352-3000 .
The enumeration date for this NPI number is 12/5/2011 and was last updated on 9/7/2012 .
Map - Location of Practice
Taxonomy Codes
The following information regarding the scope of practice of this provider is available:
| 1 |
261QA1903X |
Clinic/Center |
Ambulatory Surgical |
|
|
View Code |
Other (Legacy) Identifiers
The following legacy identifiers for this provider are available:
| 1 |
103G495427 |
MEDICARE PIN |
TN |
|
| 2 |
44C0001180 |
OTHER |
TN |
CMS CERTIFICATION # (CCN) |
NPI Record
| 1 |
NPI |
1679841738 |
| 2 |
Entity Type Code |
2 |
| 3 |
Employer Identification Number EIN |
|
| 4 |
Provider Organization Name Legal Business Name |
MUA OF MIDDLE TENNESSEE, LLC |
| 5 |
Provider First Line Business Practice Location Address |
28 WHITE BRIDGE ROAD |
| 6 |
Provider Second Line Business Practice Location Address |
SUITE 210 |
| 7 |
Provider Business Practice Location Address City Name |
NASHVILLE |
| 8 |
Provider Business Practice Location Address State Name |
TN |
| 9 |
Provider Business Practice Location Address Postal Code |
372051499 |
| 10 |
Provider Business Practice Location Address Country Code If outside U S |
US |
| 11 |
Provider Business Practice Location Address Telephone Number |
6153564690 |
| 12 |
Provider Business Practice Location Address Fax Number |
6153526673 |
| 13 |
Provider Enumeration Date |
12/5/2011 |
| 14 |
Last Update Date |
9/7/2012 |
| 15 |
Authorized Official Last Name |
SMITH |
| 16 |
Authorized Official First Name |
DEANNA |
| 17 |
Authorized Official Middle Name |
FAYE |
| 18 |
Authorized Official Title or Position |
PRACTICE ADMINISTRATOR |
| 19 |
Authorized Official Telephone Number |
6153523000 |
| 20 |
Healthcare Provider Taxonomy Code 1 |
261QA1903X |
| 21 |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
| 22 |
Other Provider Identifier 1 |
103G495427 |
| 23 |
Other Provider Identifier Type Code 1 |
08 |
| 24 |
Other Provider Identifier State 1 |
TN |
| 25 |
Other Provider Identifier 2 |
44C0001180 |
| 26 |
Other Provider Identifier Type Code 2 |
01 |
| 27 |
Other Provider Identifier State 2 |
TN |
| 28 |
Other Provider Identifier Issuer 2 |
CMS CERTIFICATION # (CCN) |
| 29 |
Is Organization Subpart |
N |
Download Record
Download this NPI record in Text format: Export
Download this NPI record in Excel (CSV) format: Export
Download this NPI record in XML format: Export
This page was last updated on: 5/14/2013
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.