Basic Information
| Provider Information | |||||||||
| NPI: | 1619205671 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASCEND MEDICAL GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 CHARLOTTE AVE | ||||||||
| Address2: | SUITE # 205 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153513304 | ||||||||
| FaxNumber: | 6157944019 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 CHARLOTTE AVE | ||||||||
| Address2: | SUITE # 205 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157305304 | ||||||||
| FaxNumber: | 6157305394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2009 | ||||||||
| LastUpdateDate: | 03/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6157305304 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 8034 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.