MEDICARE: SURGCO, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306459045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGCO, PLC

Provider Business Mailing Address
First Line	:	107 GLEN OAK BLVD STE 201A
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-3000
Country	:	US
Telephone Number	:	615-757-3451
Fax Number	:	615-757-3296

Provider Business Practice Location Address
First Line	:	107 GLEN OAK BLVD STE 201A
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-3000
Country	:	US
Telephone Number	:	615-757-3367
Fax Number	:	615-757-3426

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	LISA KAY PAGE
Credential	:
Telephone Number	:	731-693-3465

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	11/30/2020

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Directions to “SURGCO, PLC ” Practice Location

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