Provider Demographics
NPI:1548324403
Name:THE SURGICAL CLINIC, PLLC
Entity type:Organization
Organization Name:THE SURGICAL CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZSIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-301-5264
Mailing Address - Street 1:410 42ND AVE N STE 207
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3629
Mailing Address - Country:US
Mailing Address - Phone:615-301-5264
Mailing Address - Fax:
Practice Address - Street 1:410 42ND AVE N STE 207
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-3629
Practice Address - Country:US
Practice Address - Phone:615-301-5264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SURGICAL CLINIC, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455160Medicaid
TN5808230001Medicare Oscar/Certification
TN1455160Medicaid
TN5808230001Medicare NSC