Provider Demographics
NPI:1588656508
Name:SAINT THOMAS CAMPUS SURGICARE LP
Entity Type:Organization
Organization Name:SAINT THOMAS CAMPUS SURGICARE LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:4230 HARDING PIKE
Mailing Address - Street 2:PLAZA EAST, SUITE 300
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2013
Mailing Address - Country:US
Mailing Address - Phone:615-783-1261
Mailing Address - Fax:615-783-1261
Practice Address - Street 1:4230 HARDING PIKE
Practice Address - Street 2:PLAZA EAST, SUITE 300
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-783-1260
Practice Address - Fax:615-783-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000143261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4042363OtherBLUE CROSS BLUE SHIELD TN
TN3288708Medicaid
TN490005604OtherRAILROAD MEDICARE
TN0430591OtherHEALTHSPRINGS
TN103660100OtherU.S. DEPT OF LABOR
TN2890510OtherAETNA
KY36001295Medicaid
TN490005604OtherRAILROAD MEDICARE
TN4042363OtherBLUE CROSS BLUE SHIELD TN