Provider Demographics
NPI:1720041254
Name:ATRIUM SURGERY CENTER, LTD., A TENNESSEE LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:ATRIUM SURGERY CENTER, LTD., A TENNESSEE LIMITED PARTNERSHIP
Other - Org Name:ATRIUM MEMORIAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEDTKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-344-5507
Mailing Address - Street 1:1949 GUNBARREL RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3188
Mailing Address - Country:US
Mailing Address - Phone:423-495-3551
Mailing Address - Fax:423-495-3596
Practice Address - Street 1:1949 GUNBARREL RD
Practice Address - Street 2:SUITE 290
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3188
Practice Address - Country:US
Practice Address - Phone:423-495-3551
Practice Address - Fax:423-495-3596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000063261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3287589Medicaid
TN3287589Medicaid