Healthcare Provider Details

I. General information

NPI: 1417983099
Provider Name (Legal Business Name): THE SURGICAL CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 42ND AVE N STE 400
NASHVILLE TN
37209-3658
US

IV. Provider business mailing address

PO BOX 291626
NASHVILLE TN
37229-1626
US

V. Phone/Fax

Practice location:
  • Phone: 615-346-6213
  • Fax: 615-346-6225
Mailing address:
  • Phone: 615-346-6213
  • Fax: 615-346-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JOHN BOSKIND
Title or Position: PRESIDENT
Credential:
Phone: 615-292-5722