Healthcare Provider Details

I. General information

NPI: 1326244336
Provider Name (Legal Business Name): LAWRENCEBURG SURGICAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 S LOCUST AVE
LAWRENCEBURG TN
38464-4040
US

IV. Provider business mailing address

1321 S LOCUST AVE
LAWRENCEBURG TN
38464-4040
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-9993
  • Fax: 931-762-9994
Mailing address:
  • Phone: 931-762-9993
  • Fax: 931-762-9994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number42468
License Number StateTN

VIII. Authorized Official

Name: ISABELLA FLORES-MERRITT
Title or Position: CEO
Credential: MD
Phone: 931-762-9993