MEDICARE: TRANSSOUTH HEALTH CARE 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	261QA1903X	Ambulatory Surgical Clinic/Center	0000000070	TN

General Provider Information

NPI Number	:	1740277821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSSOUTH HEALTH CARE PLLC

Provider Business Mailing Address
First Line	:	ONE GI CREDENTIALING DEPARTMENT
Second Line	:	PO BOX 381468
City	:	GERMANTOWN
State	:	TN
Zip	:	38183-1468
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 PHYSICIANS DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2071
Country	:	US
Telephone Number	:	731-661-0086
Fax Number	:	731-661-0281

Authorized Official
Title or Position	:	DIRECTOR, CREDENTIALING
Name	:	KRISTINA MATERNA
Credential	:
Telephone Number	:	901-377-8219

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	02/03/2026

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