MEDICARE: NWTSC,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	123	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	490004765	OTHER	TN	RAILROAD MEDICARE

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
2	3151795	OTHER	TN	BLUE CROSS/TNCARE SELECT
3	166028900	OTHER	TN	DEPT OF LABOR
4	15982	OTHER	TN	TLC

General Provider Information

NPI Number	:	1538164504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NWTSC,LLC

Provider Business Mailing Address
First Line	:	1722 E REELFOOT AVE
Second Line	:	STE 1
City	:	UNION CITY
State	:	TN
Zip	:	38261-6050
Country	:	US
Telephone Number	:	731-885-6300
Fax Number	:	731-885-6386

Provider Business Practice Location Address
First Line	:	1722 E REELFOOT AVE
Second Line	:	STE 1
City	:	UNION CITY
State	:	TN
Zip	:	38261-6050
Country	:	US
Telephone Number	:	731-885-6300
Fax Number	:	731-885-6386

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MELINDA COOPER
Credential	:
Telephone Number	:	731-885-6300

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/30/2009

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Directions to “NWTSC,LLC ” Practice Location

Language	Start Address	Practice Location

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