Provider Demographics
NPI:1790348142
Name:THE PLASTIC SURGERY CENTER BRENTWOOD
Entity Type:Organization
Organization Name:THE PLASTIC SURGERY CENTER BRENTWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/OR DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:615-771-7718
Mailing Address - Street 1:620 CHURCH STREET EAST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-771-7718
Mailing Address - Fax:615-410-2096
Practice Address - Street 1:620 CHURCH STREET EAST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-771-7718
Practice Address - Fax:615-410-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-20
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1639313083OtherNPI