Provider Demographics
NPI:1518037811
Name:GERMANTOWN AMBULATORY SURGICAL LLC
Entity Type:Organization
Organization Name:GERMANTOWN AMBULATORY SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:ROYAL
Authorized Official - Last Name:LANGSDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-756-5474
Mailing Address - Street 1:7499 POPLAR PIKE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-5934
Mailing Address - Country:US
Mailing Address - Phone:901-755-6465
Mailing Address - Fax:901-757-5543
Practice Address - Street 1:7499 POPLAR PIKE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-5934
Practice Address - Country:US
Practice Address - Phone:901-755-6465
Practice Address - Fax:901-757-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000059261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3287882Medicare PIN