MEDICARE: SURGERY CLINIC OF PHILADELPHIA

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	208D00000X	General Practice Physician
2	261Q00000X	Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00258672	OTHER	MS	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1861578536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGERY CLINIC OF PHILADELPHIA

Provider Business Mailing Address
First Line	:	1003 HOLLAND AVE
Second Line	:	SUITE 101
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-2180
Country	:	US
Telephone Number	:	601-663-1234
Fax Number	:	601-663-1236

Provider Business Practice Location Address
First Line	:	1003 HOLLAND AVE
Second Line	:	SUITE 101
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-2180
Country	:	US
Telephone Number	:	601-663-1234
Fax Number	:	601-663-1236

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. SCOTT MCNAIR
Credential	:
Telephone Number	:	601-663-1233

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	09/22/2017

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Practice Location Address:

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Directions to “SURGERY CLINIC OF PHILADELPHIA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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