Provider Demographics
NPI:1942413943
Name:ROCK BRIDGE SURGICAL INSTITUTE, LLC
Entity Type:Organization
Organization Name:ROCK BRIDGE SURGICAL INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP OF OUTPATIENT SERVICES, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:BURTNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2153
Mailing Address - Street 1:PO BOX 100460
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0460
Mailing Address - Country:US
Mailing Address - Phone:770-410-4661
Mailing Address - Fax:770-410-4664
Practice Address - Street 1:2500 HOSPITAL BLVD
Practice Address - Street 2:SUITE 460
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4975
Practice Address - Country:US
Practice Address - Phone:770-410-4661
Practice Address - Fax:770-410-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical