Provider Demographics
NPI:1316390685
Name:MID-SOUTH SURGEONS, PLLC
Entity type:Organization
Organization Name:MID-SOUTH SURGEONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:931-380-3033
Mailing Address - Street 1:1222 TROTWOOD AVE.
Mailing Address - Street 2:SUITE 211
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-380-3033
Mailing Address - Fax:931-380-3944
Practice Address - Street 1:1222 TROTWOOD AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6436
Practice Address - Country:US
Practice Address - Phone:931-380-3033
Practice Address - Fax:931-380-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3719952Medicare UPIN