Provider Demographics
NPI:1346515897
Name:TIF W SIRAGUSA
Entity Type:Organization
Organization Name:TIF W SIRAGUSA
Other - Org Name:VEIN & VASCULAR CENTER OF NASHVILLE PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIF
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SIRAGUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-884-7600
Mailing Address - Street 1:5651 FRIST BLVD
Mailing Address - Street 2:SUITE 414
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2054
Mailing Address - Country:US
Mailing Address - Phone:615-884-7600
Mailing Address - Fax:
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:SUITE 414
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2054
Practice Address - Country:US
Practice Address - Phone:615-884-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN439662086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527328Medicaid
TN103I774427Medicare PIN
TN1527328Medicaid