Jellico Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

JELLICO SURGERY CENTER, LLC

Practice address

188 Hospital LN
Jellico, TN 37762-4400

Phone

(423) 405-0060

Fax

(423) 617-0872

NPI assigned

Feb 7, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Kirnjot Singh, MD

Title

President

Phone

(219) 228-4355

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1644192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644192000000",
    "number": "1184378309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10757 RANDOLPH ST",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077615",
            "telephone_number": "219-228-4355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 HOSPITAL LN",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377624400",
            "telephone_number": "423-405-0060",
            "fax_number": "423-617-0872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JELLICO SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-07",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A",
        "authorized_official_last_name": "SINGH",
        "authorized_official_first_name": "KIRNJOT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-228-4355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jellico TN Opco LLC
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• JLC Beechtree Inc
• Kabir Clinic LLC
• Mohammed Humayun Kabir, MD

• Ambulatory Surgical Clinic/Center in Jellico, TN
• Providers in Jellico, TN by specialty
• Ambulatory Surgical Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.