Provider Demographics
NPI:1790201135
Name:SURGICAL SERVICES OF EAST TENNESSEE PC
Entity Type:Organization
Organization Name:SURGICAL SERVICES OF EAST TENNESSEE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DRINNEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-979-0000
Mailing Address - Street 1:300 E MAIN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-5708
Mailing Address - Country:US
Mailing Address - Phone:423-979-0000
Mailing Address - Fax:423-979-6333
Practice Address - Street 1:300 EAST MAIN ST., SUITE 301
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601
Practice Address - Country:US
Practice Address - Phone:423-979-0000
Practice Address - Fax:423-587-4649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27099208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty