MUA OF MIDDLE TENNESSEE, LLC - NPI NUMBER 1679841738

Summary

Provider Name: MUA OF MIDDLE TENNESSEE, LLC

NPI Number: 1679841738

Clasification: Clinic/Center (261QA1903X)

Specialization: Ambulatory Surgical

Address:
28 WHITE BRIDGE RD
SUITE 210
NASHVILLE, TN
ZIP 37205

Phone Number: (615) 356-4690



Detailed Information

MUA OF MIDDLE TENNESSEE, LLC is an ambulatory surgical clinic/center in Nashville, TN. The assigned NPI number for this provider is 1679841738 and is registered as an organization entity type.

The provider's business address is:

28 WHITE BRIDGE RD
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 2/28/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QA1903X Clinic/Center Ambulatory Surgical Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 103G495427 MEDICARE PIN TN
2 44C0001180 OTHER TN CMS CERTIFICATION # (CCN)

NPI Record

No. Field Name Field Value
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 RD
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 2/28/2014
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

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This page was last updated on: 8/12/2014
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.