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Organization
EAST TENNESSEE AMBULATORY SURGERY CENTER LLC
Active
Organization
EAST TENNESSEE AMBULATORY SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM N BRANTNER MD (MEDICAL DIRECTOR)
(423) 283-7302
Entity
Organization
Contact information
Practice address
701 MED TECH PKWY, JOHNSON CITY, TN 37604-2259
(423) 283-7302
(423) 282-3670
Mailing address
701 MED TECH PKWY, JOHNSON CITY, TN 37604-2259
(423) 283-7302
(423) 282-3670
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000109
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007447071
AETNA
—
01
—
145422
UMWA
—
01
—
3135707
BCBS TENNCARE
TN
01
—
3135707
BCBS OF TN
—
05
—
3288092
—
TN
Enumeration date
10/18/2005
Last updated
04/20/2008
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