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General NPI Number Information
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NPI Number | 1659360071
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Entity Type | Organization
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Legal Business Name | EAST TENNESSEE AMBULATORY SURGERY CENTER LLC
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 701 MED TECH PKWY
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2259
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Country | US
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Telephone | 423-283-7302
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Fax | 423-282-3670
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Provider Business Mailing Address
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Address Line | 701 MED TECH PKWY
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2259
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Country | US
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Telephone | 423-283-7302
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Fax | 423-282-3670
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JIM N BRANTNER
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Credential | MD
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Telephone | 423-283-7302
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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 | 0000000109
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License Number State | TN
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