Provider Demographics
NPI:1093717845
Name:NASHVILLE PLASTIC SURGERY INSTITUTE, PLLC
Entity Type:Organization
Organization Name:NASHVILLE PLASTIC SURGERY INSTITUTE, PLLC
Other - Org Name:MAXWELL AESTHETICS PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-292-7708
Mailing Address - Street 1:2020 21ST AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4354
Mailing Address - Country:US
Mailing Address - Phone:615-932-7700
Mailing Address - Fax:615-932-7707
Practice Address - Street 1:2020 21ST AVE S STE 100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4354
Practice Address - Country:US
Practice Address - Phone:615-932-7700
Practice Address - Fax:615-932-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13577208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3712326Medicare ID - Type UnspecifiedMEDICARE, CIGNA, PART B