Provider Demographics
NPI:1356000830
Name:DG SURGICAL-NASHVILLE, LLC
Entity type:Organization
Organization Name:DG SURGICAL-NASHVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRUINSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-293-4769
Mailing Address - Street 1:3910 BRIGADOON CT SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8581
Mailing Address - Country:US
Mailing Address - Phone:616-293-4769
Mailing Address - Fax:
Practice Address - Street 1:1821 N WASHINGTON ST # 2221
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2221
Practice Address - Country:US
Practice Address - Phone:931-455-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty