# G. BAKER HUBBARD AMBULATORY SURGERY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548221781
- **Authorized official:** MR. CARL E RUDD (ADMINISTRATOR)
- **Authorized official phone:** (731) 422-0330

## Contact information

- **Practice address:** 616 W FOREST AVE, JACKSON, TN 38301-3902
- **Practice address phone:** (731) 422-0330
- **Practice address fax:** (731) 422-0478
- **Mailing address:** 616 W FOREST AVE, JACKSON, TN 38301-3902
- **Mailing address phone:** (731) 422-0330
- **Mailing address fax:** (731) 422-0478

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 0000000030 | TN | Yes |

## Other

- **Enumeration date:** 03/29/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3287378 | — | TN |