Provider Demographics
NPI:1811090350
Name:GREEN SURGERY CENTER LLC
Entity type:Organization
Organization Name:GREEN SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-452-1602
Mailing Address - Street 1:854 LONE OAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066
Mailing Address - Country:US
Mailing Address - Phone:615-452-1602
Mailing Address - Fax:615-451-0139
Practice Address - Street 1:854 LONE OAK DRIVE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-452-1602
Practice Address - Fax:615-451-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000110261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
490004734OtherMEDICARE RAILROAD
8356899OtherCIGNA
TN3158726OtherBCBS
TN3288441Medicaid
3158726OtherTENNCARE SELECT
7957161OtherAETNA
490004734OtherMEDICARE RAILROAD