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General NPI Number Information
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NPI Number | 1720001928
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Entity Type | Organization
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Legal Business Name | CAMPBELL CLINIC SURGERY CENTER, LLC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 7887 WOLF RIVER BLVD
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City | GERMANTOWN
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State | TN
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Zip | 38138-1718
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Country | US
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Telephone | 901-759-5464
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Fax | 901-759-5476
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Provider Business Mailing Address
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Address Line | 7887 WOLF RIVER BLVD
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City | GERMANTOWN
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State | TN
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Zip | 38138-1718
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Country | US
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Telephone | 901-759-5464
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Fax | 901-759-5476
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TIFFANY D MONK
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Credential | RN, BSN, CASC
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Telephone | 901-759-5454
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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 |
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License Number State |
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