Provider Demographics
NPI:1659354074
Name:SPECIALTY SURGERY CENTER, PLLC
Entity Type:Organization
Organization Name:SPECIALTY SURGERY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-484-2500
Mailing Address - Street 1:116 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-7703
Mailing Address - Country:US
Mailing Address - Phone:931-484-2500
Mailing Address - Fax:931-456-7659
Practice Address - Street 1:116 BROWN AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-7703
Practice Address - Country:US
Practice Address - Phone:931-484-2500
Practice Address - Fax:931-456-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000091261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3287828Medicaid
TN1659354074OtherNPI
TN3287828Medicare ID - Type Unspecified