Provider Demographics
NPI:1689632119
Name:CHILDREN'S WEST SURGERY CENTER
Entity Type:Organization
Organization Name:CHILDREN'S WEST SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:WOMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CNOR
Authorized Official - Phone:865-560-0303
Mailing Address - Street 1:1020 CHILDRENS WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-7712
Mailing Address - Country:US
Mailing Address - Phone:865-560-0303
Mailing Address - Fax:865-670-9082
Practice Address - Street 1:1020 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-7712
Practice Address - Country:US
Practice Address - Phone:865-560-0303
Practice Address - Fax:865-670-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000141261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3288726Medicare ID - Type Unspecified