Provider Demographics
NPI:1407824436
Name:ORAL FACIAL SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ORAL FACIAL SURGERY CENTER, LLC
Other - Org Name:SPECIALTY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STIRLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-321-6161
Mailing Address - Street 1:410 42ND AVE N STE 300
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3656
Mailing Address - Country:US
Mailing Address - Phone:615-321-6161
Mailing Address - Fax:615-645-9870
Practice Address - Street 1:410 42ND AVE N STE 300
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-3656
Practice Address - Country:US
Practice Address - Phone:615-321-6161
Practice Address - Fax:615-645-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000014261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3287451Medicaid
TN3287451Medicare ID - Type Unspecified