MEDICARE: SPRINGFIELD SURGERY,P.C.

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	282N00000X	General Acute Care Hospital
2	208600000X	Surgery Physician	MD010445	TN

General Provider Information

NPI Number	:	1619928744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGFIELD SURGERY,P.C.

Provider Business Mailing Address
First Line	:	322 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3963
Country	:	US
Telephone Number	:	615-384-2714
Fax Number	:	615-384-6568

Provider Business Practice Location Address
First Line	:	322 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3963
Country	:	US
Telephone Number	:	615-384-2714
Fax Number	:	615-384-6568

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MELISSA R JOHNSON
Credential	:
Telephone Number	:	615-384-2714

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	12/30/2010

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