MEDICARE: ORAL FACIAL SURGERY CENTER, LLC

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
1	261QA1903X	Ambulatory Surgical Clinic/Center	0000000014	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407824436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORAL FACIAL SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	410 42ND AVE N STE 300
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-3656
Country	:	US
Telephone Number	:	615-321-6161
Fax Number	:	615-645-9870

Provider Business Practice Location Address
First Line	:	410 42ND AVE N STE 300
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-3656
Country	:	US
Telephone Number	:	615-321-6161
Fax Number	:	615-645-9870

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHRIS STIRLING
Credential	:
Telephone Number	:	615-321-6161

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	03/01/2023

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