Basic Information
| Provider Information | |||||||||
| NPI: | 1508144809 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRAUOM LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TREATMENT ROOMS OF AMERICA UOM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2996 KATE BOND RD | ||||||||
| Address2: | 307 | ||||||||
| City: | BARTLETT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381334030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013738333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2996 KATE BOND RD | ||||||||
| Address2: | 307 | ||||||||
| City: | BARTLETT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381334030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013738333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2011 | ||||||||
| LastUpdateDate: | 08/03/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9013738333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UROLOGY OF MEMPHIS PLLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | I | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.