Provider Demographics
NPI:1053896886
Name:TENNESSEE SURGICAL PA ASSOCIATES, PLLC
Entity type:Organization
Organization Name:TENNESSEE SURGICAL PA ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAMS NPI ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STAYSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-598-2800
Mailing Address - Street 1:4117 HILLSBORO PIKE # 103-401
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2728
Mailing Address - Country:US
Mailing Address - Phone:615-398-8734
Mailing Address - Fax:
Practice Address - Street 1:4117 HILLSBORO PIKE # 103-401
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2728
Practice Address - Country:US
Practice Address - Phone:615-398-8734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty