Provider Demographics
NPI:1053378505
Name:MID-SOUTH SURGEONS, PLLC
Entity type:Organization
Organization Name:MID-SOUTH SURGEONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHY PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:931-380-3033
Mailing Address - Street 1:1222 TROTWOOD AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6436
Mailing Address - Country:US
Mailing Address - Phone:931-380-3033
Mailing Address - Fax:931-388-3401
Practice Address - Street 1:1222 TROTWOOD AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6436
Practice Address - Country:US
Practice Address - Phone:931-380-3033
Practice Address - Fax:931-388-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3719952Medicaid
TN3719952Medicare ID - Type Unspecified