Center for Surgical Specialties, LLC
Organization Active NPI Ambulatory Surgical Clinic/Center · Shelbyville, TN
NPI 1770524878 · NPPES record last updated Aug 20, 2013
Key facts
- NPI
- 1770524878
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- License
- 0000000128 (TN)
- Legal business name
- CENTER FOR SURGICAL SPECIALTIES, LLC
- Practice address
- 310 Colloredo Blvd
Ste B
Shelbyville, TN 37160 - Phone
- (931) 684-3504
- Fax
- (931) 684-5122
- NPI assigned
- Jun 9, 2006
- Organization subpart
- No
Authorized official
- Name
- Domenic M. Canonico, MD
- Title
- Owner
- Phone
- (931) 684-3504
Practitioners 1
-
Domenic Michael Canonico, M.D.
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | 0000000128 | TN | Yes |
Addresses
Primary practice location
310 Colloredo Blvd
Ste B
Shelbyville, TN 37160
Mailing address
310 Colloredo Blvd
Ste B
Shelbyville, TN 37160
Phone (931) 684-3504
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3288771E3739743 | Medicaid | TN | |
| 4052519 | Other | TN | BCBST |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.