Basic Information
| Provider Information | |||||||||
| NPI: | 1346515897 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TIF W SIRAGUSA | ||||||||
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| OtherOrganizationName: | VEIN & VASCULAR CENTER OF NASHVILLE PLLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5651 FRIST BLVD | ||||||||
| Address2: | SUITE 414 | ||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370762054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158847600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5651 FRIST BLVD | ||||||||
| Address2: | SUITE 414 | ||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370762054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158847600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2012 | ||||||||
| LastUpdateDate: | 06/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | SIRAGUSA | ||||||||
| AuthorizedOfficialFirstName: | TIF | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6158847600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 43966 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1527328 | 05 | TN | MEDICAID |