Provider Demographics
NPI:1578300430
Name:THE CLINIC SURGOINSVILLE
Entity type:Organization
Organization Name:THE CLINIC SURGOINSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-754-9924
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:SURGOINSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37873-0066
Mailing Address - Country:US
Mailing Address - Phone:423-345-6271
Mailing Address - Fax:
Practice Address - Street 1:114 BELLAMY AVE STE B
Practice Address - Street 2:
Practice Address - City:SURGOINSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37873-2700
Practice Address - Country:US
Practice Address - Phone:423-345-6271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care