Organization
PHOENIX AMBULATORY SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY DISMUKES FORBES (BILLING MANAGER)
(615) 449-0990
Entity
Organization
Contact information
Practice address
101 PHYSICIANS WAY, LEBANON, TN 37090-4135
(615) 521-9097
Mailing address
101 PHYSICIANS WAY, LEBANON, TN 37090-4135
(615) 444-2320
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
TN
Enumeration date
11/22/2017
Last updated
01/10/2019
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