Healthcare Provider Details

I. General information

NPI: 1134213648
Provider Name (Legal Business Name): CENTENNIAL SURGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 WALLACE RD SUITE C414
NASHVILLE TN
37211-4854
US

IV. Provider business mailing address

397 WALLACE RD SUITE C414
NASHVILLE TN
37211-4854
US

V. Phone/Fax

Practice location:
  • Phone: 615-781-9499
  • Fax: 615-781-3882
Mailing address:
  • Phone: 615-781-9499
  • Fax: 615-781-3882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GARY DUNCAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-661-1611