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General NPI Number Information
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NPI Number | 1770771578
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Entity Type | Organization
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Legal Business Name | SOUTHERN SURGICAL CONSULTANTS, LLC
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Dates
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Enumeration Date | 10/06/2007
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Last Update Date | 11/11/2009
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Provider Practice Location Address
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Address Line | 1623 NASHVILLE ST SUITE 206
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City | RUSSELLVILLE
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State | KY
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Zip | 42276-8889
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Country | US
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Telephone | 270-726-9700
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Fax | 270-726-6400
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Provider Business Mailing Address
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Address Line | 1623 NASHVILLE ST SUITE 206
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City | RUSSELLVILLE
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State | KY
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Zip | 42276-8889
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Country | US
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Telephone | 270-726-9700
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Fax | 270-726-6400
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN REESE
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Credential | MD
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Telephone | 270-726-9700
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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 | TP556
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License Number State | KY
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