Provider Demographics
NPI:1629356878
Name:SURGICAL INNOVATIONS, LLC
Entity Type:Organization
Organization Name:SURGICAL INNOVATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DURKEE
Authorized Official - Suffix:
Authorized Official - Credentials:VICE PRESIDENT
Authorized Official - Phone:770-344-9819
Mailing Address - Street 1:163 BUSINESS PARK DR
Mailing Address - Street 2:SUITE #10
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-1241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:163 BUSINESS PARK DR
Practice Address - Street 2:SUITE #10
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-1241
Practice Address - Country:US
Practice Address - Phone:615-547-9077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies