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General NPI Number Information
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NPI Number | 1073593109
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Entity Type | Organization
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Legal Business Name | MARYVILLE ASC
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 1706 E LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37804-6204
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Country | US
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Telephone | 865-983-0073
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Fax | 615-234-1720
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Provider Business Mailing Address
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Address Line | 1A BURTON HILLS BLVD STE 300 ATTN:L&C
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City | NASHVILLE
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State | TN
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Zip | 37215-6153
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Country | US
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Telephone | 865-983-0073
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Fax | 615-234-1720
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEFFREY SNODGRASS
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Credential |
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Telephone | 615-665-1283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 0000000001
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License Number State | TN
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