Healthcare Provider Details

I. General information

NPI: 1306836606
Provider Name (Legal Business Name): SURGERY CENTER OF CLEVELAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 25TH ST NE
CLEVELAND TN
37311-3944
US

IV. Provider business mailing address

137 25TH ST NE
CLEVELAND TN
37311-3944
US

V. Phone/Fax

Practice location:
  • Phone: 423-472-7874
  • Fax: 423-472-2881
Mailing address:
  • Phone: 423-472-7874
  • Fax: 423-472-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0000000002
License Number StateTN

VIII. Authorized Official

Name: MRS. CONNIE DELAINE JONES
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 423-472-7874