Provider Demographics
NPI:1073763652
Name:LEBONHEUR EAST SURGERY CENTER II LP
Entity Type:Organization
Organization Name:LEBONHEUR EAST SURGERY CENTER II LP
Other - Org Name:LEBONHEUR EAST SURGERY CENTER LP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRYE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRONE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:901-516-1716
Mailing Address - Street 1:786 ESTATE PLACE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120
Mailing Address - Country:US
Mailing Address - Phone:901-287-4100
Mailing Address - Fax:901-516-1755
Practice Address - Street 1:786 ESTATE PLACE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-287-4100
Practice Address - Fax:901-516-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000042261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0117229OtherBLUE CROSS/BLUE SHIELD