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NPI Code Detail

MEDICARE: WILSON COUNTY EYE SURGERY CENTER, LLC

MEDICARE: WILSON COUNTY EYE 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/Center103TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3490005524OTHERTNRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13122518OTHERTNBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407992878
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILSON COUNTY EYE SURGERY CENTER, LLC
Provider Business Mailing Address
First Line : 1670 WEST MAIN ST
Second Line : SUITE 120
City : LEBANON
State : TN
Zip : 37087
Country : US
Telephone Number : 615-453-5155
Fax Number :
Provider Business Practice Location Address
First Line : 1670 W MAIN ST
Second Line : SUITE 120
City : LEBANON
State : TN
Zip : 37087-1344
Country : US
Telephone Number : 615-453-5155
Fax Number :
Authorized Official
Title or Position : BILLING MANAGER
Name : MRS. VIVIAN L RAGSDALE
Credential :
Telephone Number : 615-453-4906
Provider Enumeration Date : 01/30/2007
Last Update Date : 02/02/2009

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Directions to “WILSON COUNTY EYE SURGERY CENTER, LLC ” Practice Location

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