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NPI Code Detail

MEDICARE: SOUTHEAST SURGICAL, PLLC

MEDICARE: SOUTHEAST SURGICAL, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician39634TN

General Provider Information

NPI Number : 1275591851
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEAST SURGICAL, PLLC
Provider Business Mailing Address
First Line : 1265 E COLLEGE ST
Second Line : SUITE 9
City : PULASKI
State : TN
Zip : 38478-4541
Country : US
Telephone Number : 931-424-9069
Fax Number : 931-424-9079
Provider Business Practice Location Address
First Line : 1265 E COLLEGE ST
Second Line : SUITE 9
City : PULASKI
State : TN
Zip : 38478-4541
Country : US
Telephone Number : 931-424-9069
Fax Number : 931-424-9079
Authorized Official
Title or Position : MD/PRESIDENT
Name : DR. TODD JEFFERSON LUCAS
Credential : MD
Telephone Number : 931-424-9069
Provider Enumeration Date : 05/03/2006
Last Update Date : 08/01/2008

Similar Medicare Providers

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Directions to “SOUTHEAST SURGICAL, PLLC ” Practice Location

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