Provider Demographics
NPI:1841589116
Name:RENAISSANCE SURGERY CENTER OF CHATTANOOGA, LLC
Entity Type:Organization
Organization Name:RENAISSANCE SURGERY CENTER OF CHATTANOOGA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:N
Authorized Official - Last Name:POMERANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-855-6800
Mailing Address - Street 1:1801 GUNBARREL RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3130
Mailing Address - Country:US
Mailing Address - Phone:423-521-7880
Mailing Address - Fax:423-521-7881
Practice Address - Street 1:1801 GUNBARREL RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3130
Practice Address - Country:US
Practice Address - Phone:423-521-7880
Practice Address - Fax:423-521-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical