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NPI Code Detail

MEDICARE: CAMPBELL CLINIC SURGERY CENTER, LLC

MEDICARE: CAMPBELL CLINIC 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/Center

General Provider Information

NPI Number : 1720001928
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAMPBELL CLINIC SURGERY CENTER, LLC
Provider Business Mailing Address
First Line : 7887 WOLF RIVER BLVD
Second Line :
City : GERMANTOWN
State : TN
Zip : 38138-1718
Country : US
Telephone Number : 901-759-5464
Fax Number : 901-759-5476
Provider Business Practice Location Address
First Line : 7887 WOLF RIVER BLVD
Second Line :
City : GERMANTOWN
State : TN
Zip : 38138-1718
Country : US
Telephone Number : 901-759-5464
Fax Number : 901-759-5476
Authorized Official
Title or Position : ADMINISTRATOR
Name : TIFFANY D MONK
Credential : RN, BSN, CASC
Telephone Number : 901-759-5454
Provider Enumeration Date : 07/26/2006
Last Update Date : 06/17/2021

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