Provider Demographics
NPI:1336190214
Name:MAURY REGIONAL AMBULATORY CARE CENTER INC.
Entity Type:Organization
Organization Name:MAURY REGIONAL AMBULATORY CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-381-1111
Mailing Address - Street 1:1218 TROTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6406
Mailing Address - Country:US
Mailing Address - Phone:931-540-4140
Mailing Address - Fax:931-540-4143
Practice Address - Street 1:1218 TROTWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6406
Practice Address - Country:US
Practice Address - Phone:931-540-4140
Practice Address - Fax:931-540-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732438Medicaid
TNDE2565Medicare PIN
TN3732438Medicare PIN