Provider Demographics
NPI:1568758241
Name:ASCEND MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:ASCEND MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MONTOGMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-441-6317
Mailing Address - Street 1:2001 CHARLOTTE AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2032
Mailing Address - Country:US
Mailing Address - Phone:731-441-6317
Mailing Address - Fax:731-937-4150
Practice Address - Street 1:115 HIGHWAY 641 S
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1639
Practice Address - Country:US
Practice Address - Phone:731-441-6317
Practice Address - Fax:731-937-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8034261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain