Provider Demographics
NPI:1053381236
Name:METHODIST SURGERY CENTER GERMANTOWN LP
Entity type:Organization
Organization Name:METHODIST SURGERY CENTER GERMANTOWN LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHERRYE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRONE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:901-516-1716
Mailing Address - Street 1:1363 SOUTH GERMANTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-624-6634
Mailing Address - Fax:901-516-1755
Practice Address - Street 1:1363 SOUTH GERMANTOWN ROAD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-624-6634
Practice Address - Fax:901-516-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN084261QA1903X
TN0000000084261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4900003520OtherRAILROAD MEDICARE
TN3075179OtherBLUE CROSS BLUE SHIELD
TN4900003520OtherRAILROAD MEDICARE