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Organization
MOUNTAIN EMPIRE SURGERY CENTER LP
Active
Organization
MOUNTAIN EMPIRE SURGERY CENTER LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN OCONNOR (AUTHORIZED OFFICIAL)
(615) 376-7315
Entity
Organization
Contact information
Practice address
601 MED TECH PKWY, JOHNSON CITY, TN 37604
(423) 610-1020
(423) 610-1021
Mailing address
601 MED TECH PKWY, JOHNSON CITY, TN 37604-2253
(423) 610-1020
(423) 610-1021
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000120
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3150816
BLUE CROSS BLUE SHIELD
TN
05
—
3281998
—
TN
01
—
490004752
MEDICARE RAILROAD
TN
Enumeration date
06/10/2005
Last updated
10/14/2024
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