Provider Demographics
NPI:1720024284
Name:PMA SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:PMA SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-232-6120
Mailing Address - Street 1:101 MED TECH PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4007
Mailing Address - Country:US
Mailing Address - Phone:423-232-6120
Mailing Address - Fax:
Practice Address - Street 1:101 MED TECH PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4007
Practice Address - Country:US
Practice Address - Phone:423-232-6120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN010OtherJOHN DEERE
TN0007949702OtherAETNA
TN3288982Medicaid
TN4097786OtherBC/BS
TNP00188946OtherMEDICARE RAILROAD
TN4097786OtherBC/BS