Healthcare Provider Details

I. General information

NPI: 1982147070
Provider Name (Legal Business Name): NORTHWEST TN SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 E REELFOOT AVE SUITE 104
UNION CITY TN
38261-6050
US

IV. Provider business mailing address

1722 E REELFOOT AVE SUITE 104
UNION CITY TN
38261-6050
US

V. Phone/Fax

Practice location:
  • Phone: 731-885-6300
  • Fax: 615-620-9301
Mailing address:
  • Phone: 731-885-6300
  • Fax: 615-620-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL D CALFEE
Title or Position: CEO
Credential: M.D.
Phone: 731-885-6300