Provider Demographics
NPI:1164144648
Name:BISE, PLLC
Entity Type:Organization
Organization Name:BISE, PLLC
Other - Org Name:SURGOINSVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-345-0333
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:SURGOINSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37873-0105
Mailing Address - Country:US
Mailing Address - Phone:423-345-0333
Mailing Address - Fax:
Practice Address - Street 1:114 BELLAMY AVE
Practice Address - Street 2:
Practice Address - City:SURGOINSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37873-2700
Practice Address - Country:US
Practice Address - Phone:423-345-0333
Practice Address - Fax:423-345-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy