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General NPI Number Information
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NPI Number | 1346211539
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Entity Type | Organization
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Legal Business Name | SURGERY CLINIC OF TUPELO PA
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 12/14/2018
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Provider Practice Location Address
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Address Line | 499 GLOSTER CREEK VLG STE S1
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City | TUPELO
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State | MS
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Zip | 38801-4708
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Country | US
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Telephone | 662-377-6470
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Fax | 662-377-6475
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Provider Business Mailing Address
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Address Line | 454 E PRESIDENT AVE
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City | TUPELO
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State | MS
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Zip | 38801-5501
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Country | US
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Telephone | 662-377-6470
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Fax | 662-377-6475
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | TERECIA SPAIN
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Credential |
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Telephone | 662-377-6472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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