Provider Demographics
NPI:1275716680
Name:MIDDLE TENNESSEE PLASTIC SURGERY, P.C.
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE PLASTIC SURGERY, P.C.
Other - Org Name:DAVID S. MARTIN, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-907-1015
Mailing Address - Street 1:820 MEDICAL CENTER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:615-599-1966
Mailing Address - Fax:615-599-9536
Practice Address - Street 1:820 MEDICAL CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-599-1966
Practice Address - Fax:615-599-9536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26589208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3090992Medicaid
TN1340038OtherUNITED HEALTHCARE
TN3012386OtherBLUE CROSS BLUE SHIELD
TN3012386OtherBLUE CROSS BLUE SHIELD
TNGO3004Medicare UPIN