Healthcare Provider Details

I. General information

NPI: 1013964063
Provider Name (Legal Business Name): BRISTOL SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BLOUNTVILLE HWY SUITE 108
BRISTOL TN
37620-0213
US

IV. Provider business mailing address

350 BLOUNTVILLE HWY SUITE 108
BRISTOL TN
37620-0213
US

V. Phone/Fax

Practice location:
  • Phone: 423-844-6120
  • Fax: 423-844-6119
Mailing address:
  • Phone: 423-844-6120
  • Fax: 423-844-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0000000052
License Number StateTN

VIII. Authorized Official

Name: MRS. KAREN J WILLIAMS
Title or Position: ADMINISTRATOR
Credential:
Phone: 423-844-6120