Healthcare Provider Details

I. General information

NPI: 1457134595
Provider Name (Legal Business Name): IPC SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 BUSINESS PARK DR NE
CLEVELAND TN
37311-6503
US

IV. Provider business mailing address

PO BOX 2070
CLEVELAND TN
37320-2070
US

V. Phone/Fax

Practice location:
  • Phone: 423-339-9581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KARI WIDDIFIELD
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 423-339-9581