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KENTUCKY LAKE SURGERY CENTER LLC
NPI 1033102397
Clinic/Center - Ambulatory Surgical in Paris, TN

Active since August 23, 2005
1002 CORNERSTONE DR, SUITE B, PARIS, TN 38242(731) 644-2150(731) 644-0474 Get Directions Write a Review

NPPES record last updated: January 28, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Kentucky Lake Surgery Center Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENTUCKY LAKE SURGERY CENTER LLC (NPI 1033102397) is a healthcare organization registered as an ambulatory surgical in Paris, Tennessee and active in the NPI registry since August 2005. The organization lists Karolyn M Mobley, Administrator, as its authorized official.

NPPES Registry Identity

NPI1033102397
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameKENTUCKY LAKE SURGERY CENTER LLC
Location Address1002 CORNERSTONE DR, SUITE BParis, TN 38242-5812
Mailing Address1002 Cornerstone Dr, Suite BParis, TN 38242-5812 · (731) 644-2150 · Fax (731) 644-0474
Phone(731) 644-2150
Fax(731) 644-0474
Organization SubpartNo
Authorized OfficialKarolyn M MobleyAdministrator · (731) 644-2150
Enumeration DateAugust 23, 2005
Last NPPES UpdateJanuary 28, 2011
✔ NPI 1033102397 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
License✔ Licensed in TN · 0000000118
1002 CORNERSTONE DR, Paris, TN 38242
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Other Identifiers 4

Other3144925TN · Blue Cross Provider Numbe
Medicare ID-Type Unspecified3288139TN · Medicare Provider Number
Medicaid3288139TN
Other490004547TN · Palmeto Gba Provider Numb

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TAMARA M ROBERTSON FNP
Nurse Practitioner
1002 CORNERSTONE DR, SUITE A
PARIS, TN 38242
Henry County (731) 642-8884
JOE DICK MOBLEY JR. MD
Urology
1002 CORNERSTONE DR, STE A
PARIS, TN 38242
Henry County (731) 642-8884
KENTUCKY LAKE UROLOGY CLINIC
Urology
1002 CORNERSTONE DR, STE A
PARIS, TN 38242
Henry County (731) 642-8884

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kentucky Lake Surgery Center LLC's NPI number?

The NPI number for Kentucky Lake Surgery Center LLC is 1033102397. It was assigned to this organization in the NPPES registry on August 23, 2005.

Where is Kentucky Lake Surgery Center LLC located?

Kentucky Lake Surgery Center LLC is located at 1002 Cornerstone Dr Suite B, Paris, TN 38242. The listed phone number is (731) 644-2150.

What is Kentucky Lake Surgery Center LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

When was this NPI record last updated?

The NPPES record for Kentucky Lake Surgery Center LLC was last updated on January 28, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.