Provider Demographics
NPI:1134213648
Name:CENTENNIAL SURGICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:CENTENNIAL SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-661-1611
Mailing Address - Street 1:397 WALLACE RD
Mailing Address - Street 2:SUITE C414
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4854
Mailing Address - Country:US
Mailing Address - Phone:615-781-9499
Mailing Address - Fax:615-781-3882
Practice Address - Street 1:397 WALLACE RD
Practice Address - Street 2:SUITE C414
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4854
Practice Address - Country:US
Practice Address - Phone:615-781-9499
Practice Address - Fax:615-781-3882
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHSERV AQUISITION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1134213648Medicaid
TN3736306Medicaid
TN3736306Medicaid
TNDG3808Medicare PIN