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NPI Code Detail

MEDICARE: WARTBURG SURGERY CENTER LLC

MEDICARE: WARTBURG SURGERY CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center0000000133TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104055425
Entity Type Code : Organization
Provider Name (Legal Business Name) : WARTBURG SURGERY CENTER LLC
Provider Business Mailing Address
First Line : PO BOX 388
Second Line :
City : WARTBURG
State : TN
Zip : 37887-0388
Country : US
Telephone Number : 423-346-2015
Fax Number : 423-346-7541
Provider Business Practice Location Address
First Line : 1236 KNOXVILLE HWY
Second Line :
City : WARTBURG
State : TN
Zip : 37887-4200
Country : US
Telephone Number : 423-346-2015
Fax Number : 423-346-7541
Authorized Official
Title or Position : CO-OWNER
Name : MR. TIMOTHY S OCHS
Credential : CRNA
Telephone Number : 423-346-2015
Provider Enumeration Date : 07/08/2009
Last Update Date : 07/21/2022

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Directions to “WARTBURG SURGERY CENTER LLC ” Practice Location

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