Provider Demographics
NPI:1114990231
Name:SURGERY CENTER OF MIDDLE TENNESSEE LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF MIDDLE TENNESSEE LLC
Other - Org Name:THE SURGERY CENTER OF MIDDLE TENNESSEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGRASS
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:931-388-3488
Mailing Address - Fax:931-388-1859
Practice Address - Street 1:1050 N JAMES CAMPBELL BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2754
Practice Address - Country:US
Practice Address - Phone:931-388-3488
Practice Address - Fax:931-388-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000099261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3287993Medicaid
TN490004949OtherRAILROAD MEDICARE
TN490004949OtherRAILROAD MEDICARE
TN3287993Medicaid
TN3287993Medicare PIN