Provider Demographics
NPI:1477876746
Name:UNIVERSITY SURGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:UNIVERSITY SURGICAL ASSOCIATES, LLC
Other - Org Name:USA PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-267-0466
Mailing Address - Street 1:2108 E 3RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2600
Mailing Address - Country:US
Mailing Address - Phone:423-493-2395
Mailing Address - Fax:423-493-2365
Practice Address - Street 1:2108 E 3RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2600
Practice Address - Country:US
Practice Address - Phone:423-493-2395
Practice Address - Fax:423-493-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPRO94224P00000X
TNPRO183224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518526Medicaid
TN6326170001Medicare NSC