Provider Demographics
NPI:1053465146
Name:SPECIALTY SURGEONS, P.C.
Entity type:Organization
Organization Name:SPECIALTY SURGEONS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:COX
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-968-2732
Mailing Address - Street 1:350 BLOUNTVILLE HWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-0213
Mailing Address - Country:US
Mailing Address - Phone:423-968-2732
Mailing Address - Fax:423-968-7530
Practice Address - Street 1:350 BLOUNTVILLE HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-0213
Practice Address - Country:US
Practice Address - Phone:423-968-2732
Practice Address - Fax:423-968-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN174400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704864Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER