Provider Demographics
NPI:1326171794
Name:WILSON COUNTY EYE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:WILSON COUNTY EYE SURGERY CENTER, LLC
Other - Org Name:WILSON COUNTY ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAGSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-453-5155
Mailing Address - Street 1:1670 W MAIN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-1344
Mailing Address - Country:US
Mailing Address - Phone:615-453-5155
Mailing Address - Fax:615-444-5915
Practice Address - Street 1:1670 W MAIN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1344
Practice Address - Country:US
Practice Address - Phone:615-453-5155
Practice Address - Fax:615-444-5915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3629275Medicaid
TNP00235135OtherRRMEDICARE
TN408685534OtherTRICARE
TN408700333OtherTRICARE
TN4085359OtherBLUE CROSS BLUE SHIELD
TN4091648OtherBLUE CROSS BLUE SHIELD
TNCH7739OtherRRMEDICARE
TNP00228559OtherRRMEDICARE
TNP00235135OtherRRMEDICARE