EAST TENNESSEE AMBULATORY SURGERY CENTER LLC NPI 1659360071

NPI Information

NPI: 1659360071
Provider Name: EAST TENNESSEE AMBULATORY SURGERY CENTER LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
701 MED TECH PKWY
JOHNSON CITY, TN
ZIP 37604
Phone: (423) 283-7302
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EAST TENNESSEE AMBULATORY SURGERY CENTER LLC is an ambulatory surgical clinic center in Johnson City, TN. EAST TENNESSEE AMBULATORY SURGERY CENTER LLC NPI is 1659360071. The provider is registered as an organization entity type.

The provider's business location address is:

701 MED TECH PKWY
JOHNSON CITY, TN
ZIP 37604-259
Phone: (423) 283-7302
Fax: (423) 282-3670

The provider's authorized official is Jim N Brantner .
The authorized official title is Medical Director and has the following contact phone number (423) 283-7302.

The enumeration date for this NPI number is 10/18/2005 and was last updated on 4/20/2008.

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	0000000109	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	3288092	MEDICARE ID-TYPE UNSPECIFIED	TENNESSEE
2	145422	OTHER		UMWA
3	=========	OTHER		TRICARE
4	3288092	MEDICAID	TENNESSEE
5	3135707	OTHER		BCBS OF TN
6	0007447071	OTHER		AETNA
7	3135707	OTHER	TENNESSEE	BCBS TENNCARE

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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