Basic Information
| Provider Information | |||||||||
| NPI: | 1326287871 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SMOKY MOUNTAIN AMBULATORY SURGERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1338 PAPERMILL POINTE WAY | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379091903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655583139 | ||||||||
| FaxNumber: | 8653306323 | ||||||||
| Practice Location | |||||||||
| Address1: | 1338 PAPERMILL POINTE WAY | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379091903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655583139 | ||||||||
| FaxNumber: | 8655885711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2009 | ||||||||
| LastUpdateDate: | 03/12/2020 | ||||||||
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| AuthorizedOfficialLastName: | LENSGRAF | ||||||||
| AuthorizedOfficialFirstName: | BETH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8655583139 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | 03/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 1526056 | 05 | TN | MEDICAID |