Organization
CENTER FOR DAY SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY DAWN WILKINS (CREDENTIALING FACILITATOR)
(931) 461-5056
Entity
Organization
Contact information
Practice address
1821 N WASHINGTON ST, TULLAHOMA, TN 37388-2221
(931) 455-2005
(931) 455-4450
Mailing address
1821 N WASHINGTON ST, TULLAHOMA, TN 37388-2221
(931) 455-2005
(931) 455-4450
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
124
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3288616
—
TN
01
—
4015184
BLUE CROSS BLUE SHIELD
TN
Enumeration date
06/14/2005
Last updated
08/22/2020
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