Provider Demographics
NPI:1063452423
Name:NASHVILLE TN OPHTHALMOLOGY ASC LLC
Entity Type:Organization
Organization Name:NASHVILLE TN OPHTHALMOLOGY ASC LLC
Other - Org Name:LVC OUTPATIENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CLENDENIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:1A BURTON HILLS BLVD
Mailing Address - Street 2:ATTN: L&C
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6103
Mailing Address - Country:US
Mailing Address - Phone:615-859-3121
Mailing Address - Fax:615-859-3941
Practice Address - Street 1:907 RIVERGATE PKWY
Practice Address - Street 2:SUITE C 2020
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2324
Practice Address - Country:US
Practice Address - Phone:615-859-3121
Practice Address - Fax:615-859-3941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000149261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3739734Medicaid
TN=========OtherTRICARE - PGBA
3739734Medicare PIN