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Organization
PMA SURGERY CENTER, LLC
Active
Organization
PMA SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY BAYS (OFFICE MANAGER)
(423) 232-6120
Entity
Organization
Contact information
Practice address
101 MED TECH PKWY, SUITE 205, JOHNSON CITY, TN 37604-4007
(423) 232-6120
Mailing address
101 MED TECH PKWY, SUITE 205, JOHNSON CITY, TN 37604-4007
(423) 232-6120
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007949702
AETNA
TN
05
—
3288982
—
TN
01
—
4097786
BC/BS
TN
01
—
P00188946
MEDICARE RAILROAD
TN
01
—
TN010
JOHN DEERE
TN
Enumeration date
06/22/2006
Last updated
08/22/2020
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