Organization
PHYSICIANS PAVILION LP
Active
Other names
Physicians Pavilion Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE L REED (OFFICER, AUTHORIZED OFFICIAL)
(972) 763-3859
Entity
Organization
Contact information
Practice address
545 STONECREST PKWY, SMYRNA, TN 37167-6804
(615) 220-3720
(615) 459-9483
Mailing address
545 STONECREST PKWY, SMYRNA, TN 37167-6804
(615) 220-3720
(615) 459-9483
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000065
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000923
BLUE CROSS PROVIDER NUMBE
TN
05
—
3287552
—
TN
01
—
490002245
RAILROAD MEDICARE
TN
Enumeration date
07/05/2005
Last updated
05/27/2015
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