Provider Demographics
NPI:1316928732
Name:ST. MARY'S AMBULATORY SURGERY CENTER LLC
Entity type:Organization
Organization Name:ST. MARY'S AMBULATORY SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ASHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-545-7557
Mailing Address - Street 1:1515 SAINT MARY ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4556
Mailing Address - Country:US
Mailing Address - Phone:865-546-5075
Mailing Address - Fax:865-545-3700
Practice Address - Street 1:1515 SAINT MARY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4556
Practice Address - Country:US
Practice Address - Phone:865-546-5075
Practice Address - Fax:865-545-3700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-11
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000111261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3288405Medicare ID - Type Unspecified