Provider Demographics
NPI:1164589032
Name:PHYSICIANS SURGERY CENTER OF CHATTANOOGA, LLC
Entity Type:Organization
Organization Name:PHYSICIANS SURGERY CENTER OF CHATTANOOGA, LLC
Other - Org Name:ANESTHESIA SERVICES OF PSCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OCONNOR
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:423-889-1600
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:423-889-1600
Practice Address - Fax:423-889-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDE2541OtherRAILROAD MEDICARE
TNDE2541OtherRAILROAD MEDICARE