1033105960 NPI number — SURGERY CENTER OF OAK RIDGE, LLC

Table of content: (NPI 1033105960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033105960 NPI number — SURGERY CENTER OF OAK RIDGE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGERY CENTER OF OAK RIDGE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED FAMILY SURGERY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033105960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
944 OAK RIDGE TPKE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
OAK RIDGE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37830-6959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-865-5001
Provider Business Mailing Address Fax Number:
865-865-5005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
944 OAK RIDGE TPKE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
OAK RIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37830-6959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-835-5000
Provider Business Practice Location Address Fax Number:
865-835-5005
Provider Enumeration Date:
09/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SWINT
Authorized Official First Name:
SONYA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
865-865-5014

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  0000000125 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0140258707 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: A3783000 . This is a "JOHN DEERE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3148496 . This is a "BLUECROSS BLUESHIELD TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 00003022 . This is a "NHC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 080037499 . This is a "EEOICP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3288148 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36001022 . This is a "KENTUCKY MEDICAID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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