Provider Demographics
NPI:1811074859
Name:SURGICAL MONITORING SERVICES, LLC
Entity type:Organization
Organization Name:SURGICAL MONITORING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP, CFO & CRO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-348-4565
Mailing Address - Street 1:3 MARYLAND FARMS STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5780
Mailing Address - Country:US
Mailing Address - Phone:800-348-4565
Mailing Address - Fax:615-345-5405
Practice Address - Street 1:3 MARYLAND FARMS STE 200
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5780
Practice Address - Country:US
Practice Address - Phone:800-348-4565
Practice Address - Fax:615-345-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2084N0400X
2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1811074859Medicaid
AZ313953Medicaid
MD418219700Medicaid
ME432840700Medicaid
CT004265957Medicaid
PA1015358060001Medicaid
IN200806520AMedicaid
MO507408003Medicaid
WA7135619Medicaid
CO73883875Medicaid
SCGP4366Medicaid
WA7135619Medicaid
IN200806520AMedicaid
MD621MMedicare PIN
PA109691Medicare PIN