Provider Demographics
NPI:1487033593
Name:MIDDLE TENNESSEE ASC, LLC
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE ASC, LLC
Other - Org Name:OVATION FERTILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GOLDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-536-7738
Mailing Address - Street 1:15821 VENTURA BLVD, SUITE 625
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-858-1080
Mailing Address - Fax:
Practice Address - Street 1:345 23RD AVE NORTH, SUITE 401
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:818-858-1080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FPG LABS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-21
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000173261QA1903X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical