Organization
ENDOSCOPY CENTER OF NORTHEAST TENNESSEE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PENNY B RUTLEDGE FACMPE, MPH (FACILITY ADMINISTRATOR)
(423) 929-7111
Entity
Organization
Contact information
Practice address
310 N STATE OF FRANKLIN RD, SUITE 202, JOHNSON CITY, TN 37604-6008
(423) 929-7111
(423) 929-9448
Mailing address
310 N STATE OF FRANKLIN RD, SUITE 202, JOHNSON CITY, TN 37604-6008
(423) 929-7111
(423) 929-9448
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000056
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3287479
—
TN
Enumeration date
04/25/2006
Last updated
08/22/2020
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