Provider Demographics
NPI:1629035779
Name:PREMIER NEUROSURGERY & SPINE CTR
Entity Type:Organization
Organization Name:PREMIER NEUROSURGERY & SPINE CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEYED
Authorized Official - Middle Name:M
Authorized Official - Last Name:EMADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PH D
Authorized Official - Phone:931-393-2121
Mailing Address - Street 1:730 KINGS LANE
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388
Mailing Address - Country:US
Mailing Address - Phone:931-393-2121
Mailing Address - Fax:931-393-2666
Practice Address - Street 1:730 KINGS LANE
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388
Practice Address - Country:US
Practice Address - Phone:931-393-2121
Practice Address - Fax:931-393-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36263207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3722831Medicaid
=========OtherTHC
TN3722831Medicaid
=========OtherHEALTHSPRINGS
=========OtherBEECHSTREET
=========OtherSIGNATURE HEALTH
=========OtherTRICARE
=========OtherPHCS
=========OtherSIGNATURE HEALTH