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General NPI Number Information
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NPI Number | 1013266303
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Entity Type | Organization
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Legal Business Name | CRESTMOOR SURGICAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 09/03/2012
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 2103 CRESTMOOR RD
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City | NASHVILLE
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State | TN
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Zip | 37215-2614
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Country | US
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Telephone | 615-921-2100
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Fax | 615-921-2101
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Provider Business Mailing Address
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Address Line | 2103 CRESTMOOR RD
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City | NASHVILLE
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State | TN
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Zip | 37215-2614
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Country | US
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Telephone | 615-921-2100
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Fax | 615-921-2101
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES J WENDEL
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Credential | MD
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Telephone | 615-921-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 36486
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License Number State | TN
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