Healthcare Provider Details

I. General information

NPI: 1619928744
Provider Name (Legal Business Name): SPRINGFIELD SURGERY,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 NORTHCREST DR
SPRINGFIELD TN
37172-3963
US

IV. Provider business mailing address

322 NORTHCREST DR
SPRINGFIELD TN
37172-3963
US

V. Phone/Fax

Practice location:
  • Phone: 615-384-2714
  • Fax: 615-384-6568
Mailing address:
  • Phone: 615-384-2714
  • Fax: 615-384-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD010445
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MELISSA R JOHNSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 615-384-2714