Provider Demographics
NPI:1548422355
Name:PMA SURGERY CENTER LLC
Entity Type:Organization
Organization Name:PMA SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TURNEY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-232-6120
Mailing Address - Street 1:101 MED TECH PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4007
Mailing Address - Country:US
Mailing Address - Phone:423-232-9420
Mailing Address - Fax:423-232-9425
Practice Address - Street 1:101 MED TECH PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4007
Practice Address - Country:US
Practice Address - Phone:423-232-9420
Practice Address - Fax:423-232-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100048318OtherPHP TENNCARE
TN0007949702OtherAETNA
TN3288982Medicaid
702040581OtherCARITEN
604059200OtherUS DEPT OF LABOR
P00188946OtherMEDICARE RAILROAD
TN010OtherUNITED HEALTHCARE OF THE NEW RIVER VALLEY
4097786OtherBLUE CROSS BLUE SHIELD
TN0007949702OtherAETNA