MEDICARE: GERMANTOWN AMBULATORY SURGICAL 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	0000000059	TN

General Provider Information

NPI Number	:	1518037811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERMANTOWN AMBULATORY SURGICAL LLC

Provider Business Mailing Address
First Line	:	7499 POPLAR PIKE
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-5934
Country	:	US
Telephone Number	:	901-755-6465
Fax Number	:	901-757-5543

Provider Business Practice Location Address
First Line	:	7499 POPLAR PIKE
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-5934
Country	:	US
Telephone Number	:	901-755-6465
Fax Number	:	901-757-5543

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. PHILLIP ROYAL LANGSDON
Credential	:	M.D.
Telephone Number	:	901-756-5474

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	02/08/2012

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