Provider Demographics
NPI:1699731869
Name:MIDDLE TENNESSEE SURGICAL CARE
Entity type:Organization
Organization Name:MIDDLE TENNESSEE SURGICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN,CNOR
Authorized Official - Phone:931-507-6872
Mailing Address - Street 1:145 HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-2663
Mailing Address - Country:US
Mailing Address - Phone:931-507-6872
Mailing Address - Fax:931-507-0077
Practice Address - Street 1:145 HEALTH WAY
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2663
Practice Address - Country:US
Practice Address - Phone:931-507-6872
Practice Address - Fax:931-507-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3288780Medicare ID - Type Unspecified