Provider Demographics
NPI:1003861998
Name:PHYSICIANS SURGERY CENTER OF CHATTANOOGA, LLC
Entity Type:Organization
Organization Name:PHYSICIANS SURGERY CENTER OF CHATTANOOGA, LLC
Other - Org Name:PHYSICIANS SURGERY CENTER OF CHATTANOOGA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICARE AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OCCONOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-376-7315
Mailing Address - Street 1:924 SPRING CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3910
Mailing Address - Country:US
Mailing Address - Phone:423-899-1600
Mailing Address - Fax:423-889-2171
Practice Address - Street 1:924 SPRING CREEK ROAD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3910
Practice Address - Country:US
Practice Address - Phone:423-899-1600
Practice Address - Fax:423-889-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00071261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0873969AMedicaid
TN3288496Medicaid
TN490004679Medicare ID - Type UnspecifiedRAILROAD MEDICARE
GA0873969AMedicaid