MEDICARE: KNOXVILLE 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
1	261QA1903X	Ambulatory Surgical Clinic/Center	0000000093	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	490004267	OTHER	TN	CRMC OF TN
3	7600000800	OTHER	KY	KYMK
4	3123485	OTHER	TN	BCBS OF TN

General Provider Information

NPI Number	:	1609955517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNOXVILLE EYE SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	160 CAPITAL DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-3343
Country	:	US
Telephone Number	:	865-251-0338
Fax Number	:	865-985-0325

Provider Business Practice Location Address
First Line	:	160 CAPITAL DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-3343
Country	:	US
Telephone Number	:	865-251-0338
Fax Number	:	865-985-0325

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	CHRISTINE BURNETTE
Credential	:
Telephone Number	:	865-251-0338

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	05/10/2021

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Directions to “KNOXVILLE EYE SURGERY CENTER LLC ” Practice Location

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