Provider Demographics
NPI:1164618229
Name:JAY MICHAEL TRUSSLER DO PC
Entity Type:Organization
Organization Name:JAY MICHAEL TRUSSLER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-728-9000
Mailing Address - Street 1:585 INTERSTATE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3191
Mailing Address - Country:US
Mailing Address - Phone:931-728-9000
Mailing Address - Fax:931-728-2726
Practice Address - Street 1:585 INTERSTATE DR
Practice Address - Street 2:SUITE B
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3191
Practice Address - Country:US
Practice Address - Phone:931-728-9000
Practice Address - Fax:931-728-2726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1634207Q00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730274Medicaid
TN3730274Medicare PIN