Organization
CROWN SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DONNA MYERS RDA (COO)
(931) 455-8255
Entity
Organization
Contact information
Practice address
1956 N JACKSON ST, TULLAHOMA, TN 37388-2204
(931) 455-8255
(931) 455-9550
Mailing address
1956 N JACKSON ST, TULLAHOMA, TN 37388-2204
(931) 455-8255
(931) 455-9550
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000191
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4156852
—
TN
01
—
5441948
MEDICARE
TN
Enumeration date
07/18/2007
Last updated
08/05/2008
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