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 Field Definition 1
1 NPI 1679841738 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name MUA OF MIDDLE TENNESSEE, LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 28 WHITE BRIDGE RD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address SUITE 210 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name NASHVILLE The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name TN The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 372051499 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 6153564690 The telephone number associated with the location address of the provider being identified.
12 Provider Business Practice Location Address Fax Number 6153526673 The fax number associated with the location address of the provider being identified.
13 Provider Enumeration Date 12/5/2011 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 2/28/2014 The date that a record was last updated or changed.
15 Authorized Official Last Name SMITH The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
16 Authorized Official First Name DEANNA The first name of the authorized official.
17 Authorized Official Middle Name FAYE The middle name of the authorized official.
18 Authorized Official Title or Position PRACTICE ADMINISTRATOR The title or position of the authorized official.
19 Authorized Official Telephone Number 6153523000 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 261QA1903X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 103G495427 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
23 Other Provider Identifier Type Code 1 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier State 1 TN
25 Other Provider Identifier 2 44C0001180 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier Type Code 2 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
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: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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