Healthcare Provider Details

I. General information

NPI: 1538164504
Provider Name (Legal Business Name): NWTSC,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 E REELFOOT AVE STE 1
UNION CITY TN
38261-6050
US

IV. Provider business mailing address

1722 E REELFOOT AVE STE 1
UNION CITY TN
38261-6050
US

V. Phone/Fax

Practice location:
  • Phone: 731-885-6300
  • Fax: 731-885-6386
Mailing address:
  • Phone: 731-885-6300
  • Fax: 731-885-6386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number123
License Number StateTN

VIII. Authorized Official

Name: MRS. MELINDA COOPER
Title or Position: ADMINISTRATOR
Credential:
Phone: 731-885-6300