=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477876746
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY SURGICAL ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2010
-----------------------------------------------------
Last Update Date | 02/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2108 E 3RD ST SUITE 100
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37404-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-493-2395
-----------------------------------------------------
Fax | 423-493-2365
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2108 E 3RD ST SUITE 100
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37404-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-493-2395
-----------------------------------------------------
Fax | 423-493-2365
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL GREER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 423-267-0466
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224P00000X
-----------------------------------------------------
Taxonomy Name | Prosthetist
-----------------------------------------------------
License Number | PRO94
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 224P00000X
-----------------------------------------------------
Taxonomy Name | Prosthetist
-----------------------------------------------------
License Number | PRO183
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------