MEDICARE: PREMIER ORTHOPAEDIC 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	0000000168	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4084798	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1720011042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER ORTHOPAEDIC SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	394 HARDING PL STE 100
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-3980
Country	:	US
Telephone Number	:	615-332-3600
Fax Number	:	615-332-3630

Provider Business Practice Location Address
First Line	:	394 HARDING PL STE 100
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-3980
Country	:	US
Telephone Number	:	615-332-3600
Fax Number	:	615-332-3630

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. GINA THRONEBERRY
Credential	:	RN
Telephone Number	:	615-332-3600

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	05/05/2008

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