Healthcare Provider Details

I. General information

NPI: 1366422370
Provider Name (Legal Business Name): URLOGY AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 WOLF PARK DRIVE SUITE 101
GERMANTOWN TN
38138
US

IV. Provider business mailing address

1325 WOLF PARK DRIVE SUITE 101
GERMANTOWN TN
38138
US

V. Phone/Fax

Practice location:
  • Phone: 901-252-3403
  • Fax: 901-516-1755
Mailing address:
  • Phone: 901-252-3403
  • Fax: 901-516-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number134
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0000000134
License Number StateTN

VIII. Authorized Official

Name: MRS. SHERRYE B CRONE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 901-516-1716