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Organization

CENTER FOR SURGICAL SPECIALTIES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DOMENIC M. CANONICO MD (OWNER)
(931) 684-3504
Entity
Organization

Contact information

Practice address
310 COLLOREDO BLVD, STE B, SHELBYVILLE, TN 37160
(931) 684-3504
(931) 684-5122
Mailing address
310 COLLOREDO BLVD, STE B, SHELBYVILLE, TN 37160
(931) 684-3504
(931) 684-5122

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000128
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3288771E3739743
TN
01
4052519
BCBST
TN
Enumeration date
06/09/2006
Last updated
08/20/2013
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