Healthcare Provider Details

I. General information

NPI: 1487693123
Provider Name (Legal Business Name): CLARKSVILLE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 WEATHERLY DR
CLARKSVILLE TN
37043-8942
US

IV. Provider business mailing address

793 WEATHERLY DR
CLARKSVILLE TN
37043-8942
US

V. Phone/Fax

Practice location:
  • Phone: 931-542-2915
  • Fax: 931-648-1816
Mailing address:
  • Phone: 931-542-2915
  • Fax: 931-648-1816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0000000095
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number0000000095
License Number StateTN

VIII. Authorized Official

Name: SCOTT MONTGOMERY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 931-645-1373