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General NPI Number Information
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NPI Number | 1063307650
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Entity Type | Organization
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Legal Business Name | SOUTHERN VASCULAR AND PAIN SURGERY CENTER OLIVE BRANCH LLC
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 8990 GERMANTOWN RD STE A
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-8532
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Country | US
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Telephone | 901-350-0678
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Fax |
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Provider Business Mailing Address
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Address Line | 921 DENT RD
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City | EADS
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State | TN
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Zip | 38028-9704
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | THOMAS HODGKISS
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Credential | MD
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Telephone | 901-350-0978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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