MAURY REGIONAL MEDICAL GROUP, INC

Provider Demographics

• NPI: 1205886264
• Name: MAURY REGIONAL MEDICAL GROUP, INC
• Entity type: Organization
• Organization Name: MAURY REGIONAL MEDICAL GROUP, INC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: CFO
• Authorized Official - Prefix: MR
• Authorized Official - First Name: NICK
• Authorized Official - Middle Name: A
• Authorized Official - Last Name: SWIFT
• Authorized Official - Phone: 931-540-4255
• Mailing Address - Street 1: 854 W JAMES CAMPBELL BLVD
• Mailing Address - Street 2: SUITE 303
• Mailing Address - City: COLUMBIA
• Mailing Address - State: TN
• Mailing Address - Zip Code: 38401-4659
• Mailing Address - Country: US
• Mailing Address - Phone: 931-540-4255
• Mailing Address - Fax: 931-490-4654
• Practice Address - Street 1: 854 W JAMES CAMPBELL BLVD
• Practice Address - Street 2: SUITE 303
• Practice Address - City: COLUMBIA
• Practice Address - State: TN
• Practice Address - Zip Code: 38401-4659
• Practice Address - Country: US
• Practice Address - Phone: 931-540-4255
• Practice Address - Fax: 931-490-4654
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-11
• Last Update Date: 2024-02-20

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	261QU0200X	Ambulatory Health Care Facilities	Clinic/Center	Urgent Care	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363LA2100X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Acute Care	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
TN	3710089	Medicaid
TN	3710089	Medicaid
	3710089	Medicare PIN
	3710081	Medicare PIN
TN	3710080	Medicaid
TN	3710084	Medicaid
TN	3710086	Medicaid
	3710089	Medicare PIN
TN	3710089	Medicaid
TN	3710088	Medicaid
TN	3710081	Medicaid
	3710088	Medicare PIN
TN	CE0561	Medicare PIN
	3710080	Medicare PIN
TN	3710087	Medicaid
	3718641	Medicare PIN
	3710087	Medicare PIN
	3710084	Medicare PIN
TN	3718641	Medicaid