Provider Demographics
NPI:1063442333
Name:UNIVERSITY SURGEONS ASSOCIATES
Entity Type:Organization
Organization Name:UNIVERSITY SURGEONS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGGENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-305-9620
Mailing Address - Street 1:1924 ALCOA HWY
Mailing Address - Street 2:BOX U-11
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-6999
Mailing Address - Country:US
Mailing Address - Phone:865-305-9620
Mailing Address - Fax:865-525-3460
Practice Address - Street 1:1930 ALCOA HWY BLDG A
Practice Address - Street 2:SUITE 240
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1500
Practice Address - Country:US
Practice Address - Phone:865-305-9620
Practice Address - Fax:865-525-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3717505Medicaid
TN3717505Medicare PIN