Provider Demographics
NPI:1114010931
Name:SKYLINE SURGERY ASSOCIATES, P.L.C.
Entity Type:Organization
Organization Name:SKYLINE SURGERY ASSOCIATES, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BRELIN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:615-612-0760
Mailing Address - Street 1:3443 DICKERSON PIKE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2519
Mailing Address - Country:US
Mailing Address - Phone:615-612-0760
Mailing Address - Fax:615-612-0640
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:SUITE 270
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2519
Practice Address - Country:US
Practice Address - Phone:615-612-0760
Practice Address - Fax:615-612-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN029893208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3724554Medicaid
TN4080474OtherBCBS TN PROVIDER#
TNF02884Medicare UPIN
TN4080474OtherBCBS TN PROVIDER#