Provider Demographics
NPI:1962453175
Name:THE SURGERY CENTER OF ATHENS, LLC.
Entity Type:Organization
Organization Name:THE SURGERY CENTER OF ATHENS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN / ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-649-3300
Mailing Address - Street 1:105 N MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-4172
Mailing Address - Country:US
Mailing Address - Phone:423-649-3300
Mailing Address - Fax:
Practice Address - Street 1:105 N MEADOWS DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-4172
Practice Address - Country:US
Practice Address - Phone:423-649-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3288625Medicaid
TN4037815OtherBCBS
TN=========OtherTAX ID
TN4037815OtherBCBS