NPIMap

Organization Active NPI

Knoxville Spine Surgery LLC

  • Ambulatory Surgical Clinic/Center
  • Knoxville, TN
National Provider Identifier
1093570426
Registry record updated Feb 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
KNOXVILLE SPINE SURGERY LLC
Practice address
1128 E Weisgarber Rd Ste 100
Knoxville, TN 37909-2677
Phone
(865) 524-1869
NPI assigned
Feb 15, 2024
Last updated
Feb 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Josh Rudd
Title
Administator
Phone
(865) 524-1869

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

1128 E Weisgarber Rd Ste 100
Knoxville, TN 37909-2677

Mailing address

1932 Alcoa Hwy Ste C360
Knoxville, TN 37920-1509
Phone (865) 524-1869

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240913002944 TN Part B Supplier - Ambulatory Surgical Center 5092255240 Practice locations: Knoxville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093570426. Details of each certification follow.

Ambulatory surgical center certification: CCN 44C0001223

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Knoxville Spine Surgery, LLC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Nov 26, 2024
Last certification
Nov 26, 2024
Facility address
1128 E. Weisgarber Rd
Knoxville, TN 37909

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2307000Knoxville Spine Surgery LLC1128 Weisgarber Rd, Ste 100, Knoxville, TN 37909Certificate of waiverJun 27, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1128 E Weisgarber Rd
Ste 100
Knoxville, TN 37909
Phone (865) 251-5215

1932 Alcoa Hwy
Ste C360
Knoxville, TN 37920
Phone (865) 558-0225

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707955200000",
    "number": "1093570426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1932 ALCOA HWY STE C360",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379201509",
            "telephone_number": "865-524-1869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1128 E WEISGARBER RD STE 100",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379092677",
            "telephone_number": "865-524-1869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNOXVILLE SPINE SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-15",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A",
        "authorized_official_last_name": "RUDD",
        "authorized_official_first_name": "JOSH",
        "authorized_official_title_or_position": "ADMINISTATOR",
        "authorized_official_telephone_number": "865-524-1869",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.