Provider Demographics
NPI:1801941539
Name:RENAISSANCE HEALTH AND SURGICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:RENAISSANCE HEALTH AND SURGICAL ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-837-5801
Mailing Address - Street 1:325 S CEDAR AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380-1305
Mailing Address - Country:US
Mailing Address - Phone:423-837-5801
Mailing Address - Fax:423-837-5807
Practice Address - Street 1:325 S CEDAR AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH PITTSBURG
Practice Address - State:TN
Practice Address - Zip Code:37380-1305
Practice Address - Country:US
Practice Address - Phone:423-837-5801
Practice Address - Fax:423-837-5807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30628207VG0400X, 207VF0040X, 207VG0400X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891-08307OtherBCBS AL PROV #
TN3149771OtherBCBS TN
TN3149771OtherBCBS TN
TNG62913Medicare UPIN
TN3149771OtherBCBS TN