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General NPI Number Information
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NPI Number | 1134126097
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Entity Type | Organization
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Legal Business Name | PHYSICIAN'S SURGERY CENTER OF KNOXVILLE LLC
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Dates
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Enumeration Date | 07/06/2005
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 1819 CLINCH AVE STE 206
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City | KNOXVILLE
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State | TN
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Zip | 37916-2435
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Country | US
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Telephone | 865-522-2949
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Fax | 865-637-3259
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Provider Business Mailing Address
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Address Line | 1819 CLINCH AVE STE 206
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City | KNOXVILLE
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State | TN
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Zip | 37916-2435
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Country | US
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Telephone | 865-522-2949
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Fax | 865-637-3259
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Authorized Official
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Title or Position | OFFICER, AUTHORIZED OFFICIAL
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Name | KRISTEN O'CONNOR
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Credential |
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Telephone | 615-376-7315
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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 | 0000000028
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License Number State | TN
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