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NPI Code Detail

MEDICARE: WILSON COUNTY EYE SURGERY CENTER, LLC

MEDICARE: WILSON COUNTY EYE SURGERY CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00235135OTHERTNRRMEDICARE
7CH7739OTHERTNRRMEDICARE
8P00228559OTHERTNRRMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3408685534OTHERTNTRICARE
4408700333OTHERTNTRICARE
54085359OTHERTNBLUE CROSS BLUE SHIELD
64091648OTHERTNBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1326171794
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILSON COUNTY EYE SURGERY CENTER, LLC
Provider Business Mailing Address
First Line : 1670 W MAIN ST
Second Line : SUITE 120
City : LEBANON
State : TN
Zip : 37087-1344
Country : US
Telephone Number : 615-453-5155
Fax Number : 615-444-5915
Provider Business Practice Location Address
First Line : 1670 W MAIN ST
Second Line : SUITE 120
City : LEBANON
State : TN
Zip : 37087-1344
Country : US
Telephone Number : 615-453-5155
Fax Number : 615-444-5915
Authorized Official
Title or Position : BILLING MANAGER
Name : MRS. VIVIAN L RAGSDALE
Credential :
Telephone Number : 615-453-5155
Provider Enumeration Date : 03/14/2007
Last Update Date : 02/02/2009

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1407992878 — WILSON COUNTY EYE SURGERY CENTER, LLC
Practice Location Address:
1670 W MAIN ST , SUITE 120
LEBANON, TN
37087-1344
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Practice Fax:
1528194305 — LEBANON EYE ASSOCIATES PC
Practice Location Address:
1670 W MAIN ST , SUITE 100
LEBANON, TN
37087-1344
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Practice Fax: 615-444-5915

Directions to “WILSON COUNTY EYE SURGERY CENTER, LLC ” Practice Location

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