Organization Name:  KENTUCKY LAKE SURGERY CENTER LLC


Practice Location:
1002 CORNERSTONE DR SUITE B PARIS, TN 38242 US
Tel: 731-644-2150  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	261QA1903X	Ambulatory Health Care Facilities Clinic/Center Ambulatory Surgical	TN	0000000118

Other Provider Identifiers:

Issuer	Number	State	Type
	3288139	TN	05
PALMETO GBA PROVIDER NUMB	490004547	TN	01
BLUE CROSS PROVIDER NUMBE	3144925	TN	01

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin