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General NPI Number Information
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NPI Number | 1720024284
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Entity Type | Organization
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Legal Business Name | PMA SURGERY CENTER, LLC
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 MED TECH PKWY SUITE 205
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City | JOHNSON CITY
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State | TN
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Zip | 37604-4007
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Country | US
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Telephone | 423-232-6120
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Fax |
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Provider Business Mailing Address
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Address Line | 101 MED TECH PKWY SUITE 205
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City | JOHNSON CITY
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State | TN
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Zip | 37604-4007
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Country | US
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Telephone | 423-232-6120
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TRACY BAYS
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Credential |
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Telephone | 423-232-6120
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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 | TN
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