Organization
JACKSON MADISON SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOBBY ROUSE JR. (ASSISTANT SECRETARY)
(901) 507-6004
Entity
Organization
Contact information
Practice address
700 W FOREST AVE STE 100, JACKSON, TN 38301-3940
(901) 737-4665
(901) 328-1355
Mailing address
2020 EXETER RD, GERMANTOWN, TN 38138-3945
(901) 737-4665
(901) 328-1355
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
04/06/2022
Last updated
04/06/2022
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