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NPI Code Detail

MEDICARE: SURGICAL ALLIANCE OF MIDDLE TENNESSEE, PLC

MEDICARE: SURGICAL ALLIANCE OF MIDDLE TENNESSEE, PLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363L00000XNurse Practitioner
3208600000XSurgery Physician

General Provider Information

NPI Number : 1255387569
Entity Type Code : Organization
Provider Name (Legal Business Name) : SURGICAL ALLIANCE OF MIDDLE TENNESSEE, PLC
Provider Business Mailing Address
First Line : 417 NORTHCREST DR
Second Line :
City : SPRINGFIELD
State : TN
Zip : 37172-3963
Country : US
Telephone Number : 615-384-8211
Fax Number : 615-384-5859
Provider Business Practice Location Address
First Line : 417 NORTHCREST DR
Second Line :
City : SPRINGFIELD
State : TN
Zip : 37172-3963
Country : US
Telephone Number : 615-384-8211
Fax Number : 615-384-5859
Authorized Official
Title or Position : PRESIDENT
Name : DR. KEITH GOLDBERG
Credential : M.D.
Telephone Number : 615-384-8211
Provider Enumeration Date : 05/26/2006
Last Update Date : 09/11/2019

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