44D1094734 CLIA NUMBER - TENN SM, LLC DBA PROVIDENCE SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 44D1094734
  • Facility Name: TENN SM, LLC DBA PROVIDENCE SURGERY CENTER
  • Facility Address: 5002 CROSSING CIRCLE STE 110
    MOUNT JULIET, TN
    ZIP 37122
  • Facility Phone: 615 553-9100
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: DR. SCOTT FORTUNE
  • NPI Number: 1235395385
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 44D1094734
LAB Type Ambulance
Facility Name TENN SM, LLC DBA PROVIDENCE SURGERY CENTER
Street 5002 CROSSING CIRCLE STE 110
City MOUNT JULIET
State TN
ZIP 37122
Phone 615 553-9100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/26/2025
Certificate Expiration Date 1/25/2027
Facility Type Ambulance
Lab Director DR. SCOTT FORTUNE

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This page was last updated on: 9/29/2025