Provider Demographics
NPI:1598806408
Name:AMBULATORY SURGICAL CENTER OF WARTBURG
Entity Type:Organization
Organization Name:AMBULATORY SURGICAL CENTER OF WARTBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:REDMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-346-5566
Mailing Address - Street 1:1236 KNOXVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887
Mailing Address - Country:US
Mailing Address - Phone:423-346-5566
Mailing Address - Fax:423-346-7541
Practice Address - Street 1:1236 KNOXVILLE HWY
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887
Practice Address - Country:US
Practice Address - Phone:423-346-5566
Practice Address - Fax:423-346-7541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3288551Medicaid
TN=========OtherTAX ID
TN3288551Medicare ID - Type UnspecifiedCIGNA MEDICARE