Provider Demographics
NPI:1093131211
Name:STOKES SURGERY GROUP, PC
Entity Type:Organization
Organization Name:STOKES SURGERY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:C
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-715-9094
Mailing Address - Street 1:PO BOX 1562
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38027-1562
Mailing Address - Country:US
Mailing Address - Phone:615-484-8128
Mailing Address - Fax:901-328-5599
Practice Address - Street 1:1143 CULLY RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8502
Practice Address - Country:US
Practice Address - Phone:615-484-8128
Practice Address - Fax:901-328-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03431013Medicaid
TNQ005388Medicaid
MS353456ZG7LMedicare PIN
TN103G700710Medicare PIN