Organization
MARYVILLE SURGICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY ELLEN RIDER RN (ADMINISTRATOR)
(865) 380-9070
Entity
Organization
Contact information
Practice address
763 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5000
(865) 380-9070
(865) 380-9093
Mailing address
763 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5000
(865) 380-9070
(865) 380-9093
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000107
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3288166
—
TN
Enumeration date
08/10/2005
Last updated
08/22/2020
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