Provider Demographics
NPI:1487088498
Name:MIDDLE TENNESSEE SURGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:MIDDLE TENNESSEE SURGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-246-1689
Mailing Address - Street 1:2839 HIGHWAY 231 N
Mailing Address - Street 2:201
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-7447
Mailing Address - Country:US
Mailing Address - Phone:931-685-8663
Mailing Address - Fax:931-685-8669
Practice Address - Street 1:2839 HIGHWAY 231 N
Practice Address - Street 2:201
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-7447
Practice Address - Country:US
Practice Address - Phone:931-685-8663
Practice Address - Fax:931-685-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48189208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty