Provider Demographics
NPI:1285826925
Name:ZELLEM NEUROSURGICAL ASSO
Entity Type:Organization
Organization Name:ZELLEM NEUROSURGICAL ASSO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:ZELLEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-264-1750
Mailing Address - Street 1:242 W MAIN ST
Mailing Address - Street 2:#233
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3318
Mailing Address - Country:US
Mailing Address - Phone:615-264-1750
Mailing Address - Fax:615-264-8585
Practice Address - Street 1:353 NEW SHACKLE ISLAND RD
Practice Address - Street 2:SUITE 100A
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2379
Practice Address - Country:US
Practice Address - Phone:615-264-1750
Practice Address - Fax:615-264-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20953207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5446080001Medicare NSC
TN3726268Medicare PIN