MEDICARE: TRIDENT VEIN CENTER PLLC

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	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1477147080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIDENT VEIN CENTER PLLC

Provider Business Mailing Address
First Line	:	2040 RESERVE BLVD STE B
Second Line	:
City	:	SPRING HILL
State	:	TN
Zip	:	37174-0735
Country	:	US
Telephone Number	:	615-455-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 RESERVE BLVD STE B
Second Line	:
City	:	SPRING HILL
State	:	TN
Zip	:	37174-0735
Country	:	US
Telephone Number	:	615-455-3000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS CUNNINGHAM
Credential	:	MD
Telephone Number	:	615-455-3000

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	07/03/2024

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Directions to “TRIDENT VEIN CENTER PLLC ” Practice Location

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