Provider Demographics
NPI:1417983099
Name:THE SURGICAL CLINIC PLLC
Entity Type:Organization
Organization Name:THE SURGICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSKIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-292-5722
Mailing Address - Street 1:PO BOX 291626
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37229-1626
Mailing Address - Country:US
Mailing Address - Phone:615-346-6213
Mailing Address - Fax:615-346-6225
Practice Address - Street 1:410 42ND AVE N STE 400
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-3658
Practice Address - Country:US
Practice Address - Phone:615-346-6213
Practice Address - Fax:615-346-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3711297Medicare PIN
TN3711296Medicare ID - Type Unspecified
TN3711290Medicare ID - Type Unspecified
TN3711298Medicare ID - Type Unspecified
TN3711299Medicare ID - Type Unspecified