Provider Demographics
NPI:1073736658
Name:SURGERY CLINIC OF COLUMBUS PLLC
Entity Type:Organization
Organization Name:SURGERY CLINIC OF COLUMBUS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-328-3441
Mailing Address - Street 1:255 BAPTIST BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2006
Mailing Address - Country:US
Mailing Address - Phone:662-328-3441
Mailing Address - Fax:662-328-5540
Practice Address - Street 1:255 BAPTIST BLVD STE 306
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2006
Practice Address - Country:US
Practice Address - Phone:662-328-3441
Practice Address - Fax:662-328-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015416Medicaid
MSSO858PROtherBLUE CROSS
MSSO858PROtherBLUE CROSS