Provider Demographics
NPI:1720001928
Name:CAMPBELL CLINIC SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CAMPBELL CLINIC SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MONK
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CASC
Authorized Official - Phone:901-759-5454
Mailing Address - Street 1:7887 WOLF RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1718
Mailing Address - Country:US
Mailing Address - Phone:901-759-5464
Mailing Address - Fax:901-759-5476
Practice Address - Street 1:7887 WOLF RIVER BLVD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1718
Practice Address - Country:US
Practice Address - Phone:901-759-5464
Practice Address - Fax:901-759-5476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3288698Medicare ID - Type Unspecified