Healthcare Provider Details

I. General information

NPI: 1114034006
Provider Name (Legal Business Name): SURGICAL CENTER AT MILLBURN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 E WILLOW ST
MILLBURN NJ
07041-1416
US

IV. Provider business mailing address

1A BURTON HILLS BLVD
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 973-912-8111
  • Fax: 973-912-0181
Mailing address:
  • Phone: 615-240-3741
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number23110
License Number StateNJ

VIII. Authorized Official

Name: JEFFREY E SNODGRASS
Title or Position: PESIDENT
Credential:
Phone: 615-665-1283