NPIMap

Organization Active NPI

Wilson County Eye Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Lebanon, TN
National Provider Identifier
1407992878
Registry record updated Feb 2, 2009
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Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
103 Issued in TN
Legal business name
WILSON COUNTY EYE SURGERY CENTER, LLC
Practice address
1670 W Main St
Suite 120
Lebanon, TN 37087-1344
Phone
(615) 453-5155
NPI assigned
Jan 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2009

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

Authorized official

Name
Mrs. Vivian L Ragsdale
Title
Billing Manager
Phone
(615) 453-4906

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 103 TN Primary

Addresses

Primary practice location

1670 W Main St
Suite 120
Lebanon, TN 37087-1344

Mailing address

1670 West Main St
Suite 120
Lebanon, TN 37087
Phone (615) 453-5155

Other identifiers 3

IdentifierTypeStateIssuer
3122518OtherTNBLUE CROSS BLUE SHIELD
3288111MedicaidTN
490005524OtherTNRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 44C0001085

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
WILSON COUNTY EYE SURGERY CENTER
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Apr 29, 1999
Last certification
Jul 24, 2019
Ownership / control type
Proprietary
Facility address
1670 West Main Street, Suite 120
Lebanon, TN 37087

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233532800000",
    "number": "1407992878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 WEST MAIN ST",
            "address_2": "SUITE 120",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "37087",
            "telephone_number": "615-453-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 W MAIN ST",
            "address_2": "SUITE 120",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370871344",
            "telephone_number": "615-453-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON COUNTY EYE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2009-02-02",
        "status": "A",
        "authorized_official_last_name": "RAGSDALE",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "615-453-4906",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TN",
            "license": "103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "3122518",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3288111",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "490005524",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, TN

Sources for this page

Verify at the official NPI Registry.