Provider Demographics
NPI:1871575043
Name:AMBULATORY SURGERY CENTER OF COOL SPRINGS LLC
Entity type:Organization
Organization Name:AMBULATORY SURGERY CENTER OF COOL SPRINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:2009 MALLORY LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2845
Mailing Address - Country:US
Mailing Address - Phone:615-468-2772
Mailing Address - Fax:615-468-2666
Practice Address - Street 1:2009 MALLORY LN
Practice Address - Street 2:SUITE 100
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2845
Practice Address - Country:US
Practice Address - Phone:615-468-2772
Practice Address - Fax:615-468-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000117261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3158738OtherBLUE CROSS PROVIDER #
TN3288450Medicare ID - Type UnspecifiedMEDICARE PROVIDER #