Organization
VAN DYCK ASC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES C LODEN M.D. (OWNER/MEDICAL DIRECTOR)
(731) 642-5003
Entity
Organization
Contact information
Practice address
1024 KELLEY DR, PARIS, TN 38242-4500
(731) 642-5003
(731) 642-8756
Mailing address
1024 KELLEY DR, PARIS, TN 38242-4500
(731) 642-5003
(731) 642-8756
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
0000000023
TN
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
TN23
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3288423
—
TN
Enumeration date
07/07/2006
Last updated
02/17/2022
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