Provider Demographics
NPI:1326054172
Name:FORT SANDERS WEST OP SURGERY CENTER
Entity Type:Organization
Organization Name:FORT SANDERS WEST OP SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-531-5248
Mailing Address - Street 1:220 FORT SANDERS WEST BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3398
Mailing Address - Country:US
Mailing Address - Phone:865-531-5200
Mailing Address - Fax:865-531-5370
Practice Address - Street 1:210 FORT SANDERS WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3355
Practice Address - Country:US
Practice Address - Phone:865-531-5200
Practice Address - Fax:865-531-5370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000025261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100020229OtherPHP TNCARE
TN1000905OtherBLUE CROSS
TN3287277Medicaid
TN702002007OtherCARITEN
TN165264500OtherDEPARTMENT OF LABOR