BRISTOL SURGERY CENTER LLC NPI 1013964063

NPI Information

NPI: 1013964063
Provider Name: BRISTOL SURGERY CENTER, LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 44D0992563

Address:
350 BLOUNTVILLE HWY
SUITE 108
BRISTOL, TN
ZIP 37620
Phone: (423) 844-6120
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BRISTOL SURGERY CENTER, LLC is an ambulatory surgical clinic center in Bristol, TN. BRISTOL SURGERY CENTER, LLC NPI is 1013964063. The provider is registered as an organization entity type.

The provider's business location address is:

350 BLOUNTVILLE HWY
SUITE 108
BRISTOL, TN
ZIP 37620-213
Phone: (423) 844-6120
Fax: (423) 844-6119

The provider's authorized official is Karen J Williams .
The authorized official title is Administrator and has the following contact phone number (423) 844-6120.

The CLIA number assigned to this NPI record is 44D0992563 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/27/2006 and was last updated on 1/16/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	0000000052	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3287075	MEDICAID	TENNESSEE
2	007192	OTHER	VIRGINIA	TRIGON BCBS
3	007679301	MEDICAID	VIRGINIA
4	1000984	OTHER	TENNESSEE	BSBSTN
5	TN0103	OTHER		JOHN DEERE
6	3287075	MEDICARE ID-TYPE UNSPECIFIED	TENNESSEE	MEDICARE PROVIDER NUMBER
7	490000336	MEDICARE ID-TYPE UNSPECIFIED		RAILROAD MEDICARE
8	0004618082	OTHER		AETNA PROVIDER NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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