Provider Demographics
NPI:1255593356
Name:BRISTOL SURGERY CENTER
Entity type:Organization
Organization Name:BRISTOL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-844-6120
Mailing Address - Street 1:350 BLOUNTVILLE HWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-0213
Mailing Address - Country:US
Mailing Address - Phone:423-844-6120
Mailing Address - Fax:423-844-6119
Practice Address - Street 1:350 BLOUNTVILLE HWY
Practice Address - Street 2:SUITE 108
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-0213
Practice Address - Country:US
Practice Address - Phone:423-844-6120
Practice Address - Fax:423-844-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000052261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3610237Medicare PIN