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General NPI Number Information
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NPI Number | 1942317672
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Entity Type | Organization
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Legal Business Name | TRI-CITIES OUTPATIENT SURGERY, INC.
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 06/16/2009
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Provider Practice Location Address
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Address Line | 1009 N STATE OF FRANKLIN ACCESS ROAD SUITE B
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City | JOHNSON CITY
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State | TN
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Zip | 37604
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Country | US
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Telephone | 423-929-7546
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Fax | 423-929-7968
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Provider Business Mailing Address
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Address Line | 1009 N STATE OF FRANKLIN ACCESS ROAD SUITE B
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City | JOHNSON CITY
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State | TN
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Zip | 37604
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Country | US
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Telephone | 423-929-7546
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Fax | 423-929-7968
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | BRENDA S STUFFLESTREET
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Credential |
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Telephone | 423-929-7546
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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 | 178
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License Number State | TN
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