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General NPI Number Information
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NPI Number | 1780618942
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Entity Type | Organization
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Legal Business Name | TENNESSEE PHLEBOLOGY PC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 9020 OVERLOOK BLVD STE 150
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City | BRENTWOOD
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State | TN
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Zip | 37027-2727
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Country | US
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Telephone | 615-401-7162
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Fax | 615-401-7163
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Provider Business Mailing Address
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Address Line | PO BOX 1602
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City | NORTHBROOK
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State | IL
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Zip | 60065-1602
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Country | US
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Telephone | 847-593-8460
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Fax |
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Authorized Official
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Title or Position | SR VP REVENUE
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Name | NATHAN AMORUSO
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Credential |
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Telephone | 847-593-8460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State | TN
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