=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033105960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURGERY CENTER OF OAK RIDGE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2005
-----------------------------------------------------
Last Update Date | 04/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 944 OAK RIDGE TPKE SUITE 200
-----------------------------------------------------
City | OAK RIDGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37830-6959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-835-5000
-----------------------------------------------------
Fax | 865-835-5005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 944 OAK RIDGE TPKE SUITE 200
-----------------------------------------------------
City | OAK RIDGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37830-6959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-865-5001
-----------------------------------------------------
Fax | 865-865-5005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OFFICE MANAGER
-----------------------------------------------------
Name | MRS. SONYA SWINT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-865-5014
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 0000000125
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------