Provider Demographics
NPI:1033154851
Name:PARKWEST SURGERY CENTER LP
Entity Type:Organization
Organization Name:PARKWEST SURGERY CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:9430 PARK WEST BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4204
Mailing Address - Country:US
Mailing Address - Phone:865-531-0494
Mailing Address - Fax:865-531-0554
Practice Address - Street 1:9430 PARK WEST BLVD
Practice Address - Street 2:STE 210
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4204
Practice Address - Country:US
Practice Address - Phone:865-531-0494
Practice Address - Fax:865-531-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000136261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3288579Medicaid
TN490005366OtherRAILROAD MEDICARE
TN3288579Medicare PIN
TN44C0001112Medicare Oscar/Certification