Healthcare Provider Details

I. General information

NPI: 1881699106
Provider Name (Legal Business Name): CENTER FOR DAY SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 N WASHINGTON ST
TULLAHOMA TN
37388-2221
US

IV. Provider business mailing address

1821 N WASHINGTON ST
TULLAHOMA TN
37388-2221
US

V. Phone/Fax

Practice location:
  • Phone: 931-455-2005
  • Fax: 931-455-4450
Mailing address:
  • Phone: 931-455-2005
  • Fax: 931-455-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number124
License Number StateTN

VIII. Authorized Official

Name: TRACY DAWN WILKINS
Title or Position: CREDENTIALING FACILITATOR
Credential:
Phone: 931-461-5056