Basic Information
| Provider Information | |||||||||
| NPI: | 1952402588 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MURFREESBORO SURGICAL SPECIALISTS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 MEDICAL CENTER PKWY | ||||||||
| Address2: | SUITE 440 | ||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158671940 | ||||||||
| FaxNumber: | 6158671941 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 MEDICAL CENTER PKWY | ||||||||
| Address2: | SUITE 440 | ||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158671940 | ||||||||
| FaxNumber: | 6158671941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 07/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | WESTMORELAND | ||||||||
| AuthorizedOfficialFirstName: | MORRIS | ||||||||
| AuthorizedOfficialMiddleName: | WAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6158671940 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 12300 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3735444 | 05 | TN | MEDICAID |