Provider Demographics
NPI:1972520963
Name:UNIVERSITY SURGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:UNIVERSITY SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-757-0792
Mailing Address - Street 1:979 E 3RD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2187
Mailing Address - Country:US
Mailing Address - Phone:423-267-0466
Mailing Address - Fax:423-757-0770
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-267-0466
Practice Address - Fax:423-757-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518526Medicaid
AL529901190Medicaid
GA300040433AMedicaid
TN3706707Medicaid
TN3706706Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
TN3706703Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
TN3706702Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
TN3706701Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER