Healthcare Provider Details

I. General information

NPI: 1598629347
Provider Name (Legal Business Name): LEBANON SURGICENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WILLARD HAGAN DR
LEBANON TN
37090-1023
US

IV. Provider business mailing address

125 WILLARD HAGAN DR
LEBANON TN
37090-1023
US

V. Phone/Fax

Practice location:
  • Phone: 615-449-1150
  • Fax: 615-449-1162
Mailing address:
  • Phone: 615-449-1150
  • Fax: 615-449-1162

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: DAVID MCKNIGHT
Title or Position: VP/CFO
Credential:
Phone: 972-789-2816