1548422355 NPI number — PMA SURGERY CENTER LLC

Table of content: (NPI 1548422355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548422355 NPI number — PMA SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PMA SURGERY CENTER 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:
Provider Other Organization Name Type Code:
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:
1548422355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 MED TECH PKWY
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37604-4007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-232-9420
Provider Business Mailing Address Fax Number:
423-232-9425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MED TECH PKWY
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-232-9420
Provider Business Practice Location Address Fax Number:
423-232-9425
Provider Enumeration Date:
07/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
TURNEY
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
423-232-6120

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100048318 . This is a "PHP TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0007949702 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3288982 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 702040581 . This is a "CARITEN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 604059200 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00188946 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: TN010 . This is a "UNITED HEALTHCARE OF THE NEW RIVER VALLEY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4097786 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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