Organization
SURGERY CENTER OF CLEVELAND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE DELAINE JONES RN (ADMINISTRATOR)
(423) 472-7874
Entity
Organization
Contact information
Practice address
137 25TH ST NE, CLEVELAND, TN 37311-3944
(423) 472-7874
(423) 472-2881
Mailing address
137 25TH ST NE, CLEVELAND, TN 37311-3944
(423) 472-7874
(423) 472-2881
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000002
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100920
BLUE CROSS PROVIDER NUMBE
TN
01
—
7806130
AETNA PROVIDER NUMBER
TN
Enumeration date
10/27/2005
Last updated
08/22/2020
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