Basic Information
| Provider Information | |||||||||
| NPI: | 1114010931 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SKYLINE SURGERY ASSOCIATES, P.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3443 DICKERSON PIKE | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372072519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156120760 | ||||||||
| FaxNumber: | 6156120640 | ||||||||
| Practice Location | |||||||||
| Address1: | 3443 DICKERSON PIKE | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372072519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156120760 | ||||||||
| FaxNumber: | 6156120640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 09/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | TAYLOR | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | BRELIN | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 6156120760 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 029893 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3724554 | 05 | TN | MEDICAID | 4080474 | 01 | TN | BCBS TN PROVIDER# | OTHER |