Healthcare Provider Details

I. General information

NPI: 1255387569
Provider Name (Legal Business Name): SURGICAL ALLIANCE OF MIDDLE TENNESSEE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 NORTHCREST DR
SPRINGFIELD TN
37172-3963
US

IV. Provider business mailing address

417 NORTHCREST DR
SPRINGFIELD TN
37172-3963
US

V. Phone/Fax

Practice location:
  • Phone: 615-384-8211
  • Fax: 615-384-5859
Mailing address:
  • Phone: 615-384-8211
  • Fax: 615-384-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH GOLDBERG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 615-384-8211