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General NPI Number Information
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NPI Number | 1821185786
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Entity Type | Organization
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Legal Business Name | THE SURGICAL CLINIC ASSOCIATES, P.A.
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 501 MARSHALL ST SUITE 500
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City | JACKSON
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State | MS
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Zip | 39202-1651
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Country | US
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Telephone | 601-948-1411
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Fax | 601-948-0090
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Provider Business Mailing Address
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Address Line | 501 MARSHALL ST SUITE 500
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City | JACKSON
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State | MS
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Zip | 39202-1651
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Country | US
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Telephone | 601-948-1411
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Fax | 601-948-0090
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. TERRY HICKMAN
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Credential | CPA
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Telephone | 601-948-1411
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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 | MS
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