Provider Demographics
NPI:1104373315
Name:BRENTWOOD SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:BRENTWOOD SURGERY CENTER, LLC
Other - Org Name:BRENTWOOD SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-789-2877
Mailing Address - Street 1:1001 HEALTH PARK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5804
Mailing Address - Country:US
Mailing Address - Phone:615-750-8777
Mailing Address - Fax:615-750-8778
Practice Address - Street 1:1001 HEALTH PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5804
Practice Address - Country:US
Practice Address - Phone:615-750-8777
Practice Address - Fax:615-750-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN185261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN185OtherSTATE OF TENNESSEE