Provider Demographics
NPI:1366677585
Name:LAFOLLETTE GENERAL SURGERY
Entity Type:Organization
Organization Name:LAFOLLETTE GENERAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-549-4892
Mailing Address - Street 1:919 E CENTRAL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAFOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2777
Mailing Address - Country:US
Mailing Address - Phone:423-907-1680
Mailing Address - Fax:423-907-1684
Practice Address - Street 1:919 E CENTRAL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LAFOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2777
Practice Address - Country:US
Practice Address - Phone:423-907-1680
Practice Address - Fax:423-907-1684
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY PHYSICAINS SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-18
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373630Medicare Oscar/Certification