Provider Demographics
NPI:1003381799
Name:SIMMONS MEDICAL GROUP SOUTH INC
Entity Type:Organization
Organization Name:SIMMONS MEDICAL GROUP SOUTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-321-6612
Mailing Address - Street 1:18155 PENINSULA WAY
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8496
Mailing Address - Country:US
Mailing Address - Phone:734-945-8706
Mailing Address - Fax:
Practice Address - Street 1:301 HARBOUR PLACE DR UNIT 2007
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-6808
Practice Address - Country:US
Practice Address - Phone:248-321-6612
Practice Address - Fax:813-964-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty