Basic Information
Provider Information | |||||||||
NPI: | 1780964866 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BAPTIST PLAZA SURGICARE, LP | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NASHVILLE ENDOSURGERY CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 300 20TH AVE N | ||||||||
Address2: | FL 8 | ||||||||
City: | NASHVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 372032131 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6152841335 | ||||||||
FaxNumber: | 6152841316 | ||||||||
Practice Location | |||||||||
Address1: | 300 20TH AVE N | ||||||||
Address2: | 8TH FLOOR | ||||||||
City: | NASHVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 37203 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6152841335 | ||||||||
FaxNumber: | 6152841316 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/22/2011 | ||||||||
LastUpdateDate: | 07/09/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | OCONNOR | ||||||||
AuthorizedOfficialFirstName: | KRISTEN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
AuthorizedOfficialTelephone: | 6153767315 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/09/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.