Mid-State Endoscopy Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

210 Issued in TN

Legal business name

MID-STATE ENDOSCOPY CENTER LLC

Practice address

1115 Dow Street
Suite a
Murfreesboro, TN 37130-2443

Phone

(615) 848-9234

Fax

(615) 893-3188

NPI assigned

May 14, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

William Scott Montgomery

Title

Officer/Authorized Official

Phone

(615) 848-9234

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Listed as

Mid State Endoscopy CenterCCN 44C0001177

Medicare certification status

ActiveFrom the Provider of Services file

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

• Saint Thomas Health

  • Community/Retail Pharmacy
  • Nashville, TN
  • NPI 1861806911

  Member Of

  NPD member
• Baylor University Medical Center

  • General Acute Care Hospital
  • Dallas, TX
  • NPI 1447250253

  Member Of

  NPD member
• VHS San Antonio Partners LLC

  • Psychiatric Hospital Unit
  • San Antonio, TX
  • NPI 1487633509

  Member Of

  NPD member

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Mid State Endo Uap, LLC

  • Anesthesiology Physician
  • Murfreesboro, TN
  • NPI 1710309265

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774483200000",
    "number": "1598083594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 DOW ST STE A",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371302487",
            "telephone_number": "615-848-9234",
            "fax_number": "615-893-3188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 DOW STREET",
            "address_2": "SUITE A",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371302443",
            "telephone_number": "615-848-9234",
            "fax_number": "615-893-3188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-STATE ENDOSCOPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-14",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OFFICER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-848-9234"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TN",
            "license": "210",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01044051",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michelle Fowler LLC
• Sonja Mariana Michello, COTA
• Mid South Psychiatric Associates
• Mid State Endo Uap, LLC
• Mid- TN Therapeutic Clinic
• Mid-State Endoscopy Center LLC
• Mid-State Gastroenterology, PLLC
• Mid-State Neurosurgery PC
• Mid-State Surgery PLLC
• Middle Tennessee Ambulatory Surgery Center, L.P.

• Ambulatory Surgical Clinic/Center in Murfreesboro, TN
• Providers in Murfreesboro, TN by specialty
• Ambulatory Surgical Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.