Provider Demographics
NPI:1407864697
Name:MID-STATE NEUROSURGERY PC
Entity Type:Organization
Organization Name:MID-STATE NEUROSURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-849-8004
Mailing Address - Street 1:1800 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2567
Mailing Address - Country:US
Mailing Address - Phone:615-849-8004
Mailing Address - Fax:615-849-1334
Practice Address - Street 1:1800 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2567
Practice Address - Country:US
Practice Address - Phone:615-849-8004
Practice Address - Fax:615-849-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3059661Medicare ID - Type Unspecified