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Organization
BRISTOL SURGERY CENTER, LLC
Active
Organization
BRISTOL SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN J WILLIAMS (ADMINISTRATOR)
(423) 844-6120
Entity
Organization
Contact information
Practice address
350 BLOUNTVILLE HWY, SUITE 108, BRISTOL, TN 37620-0213
(423) 844-6120
(423) 844-6119
Mailing address
350 BLOUNTVILLE HWY, SUITE 108, BRISTOL, TN 37620-0213
(423) 844-6120
(423) 844-6119
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000052
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004618082
AETNA PROVIDER NUMBER
—
01
—
007192
TRIGON BCBS
VA
05
—
007679301
—
VA
01
—
1000984
BSBSTN
TN
05
—
3287075
—
TN
01
—
TN0103
JOHN DEERE
—
Enumeration date
05/27/2006
Last updated
01/16/2009
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