Provider Demographics
NPI:1164501862
Name:SURGICAL ASSOCIATES OF MARTIN PC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF MARTIN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:G
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-587-2525
Mailing Address - Street 1:300 W PEACH ST
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3949
Mailing Address - Country:US
Mailing Address - Phone:731-587-2525
Mailing Address - Fax:731-587-2555
Practice Address - Street 1:300 W PEACH ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3949
Practice Address - Country:US
Practice Address - Phone:731-587-2525
Practice Address - Fax:731-587-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725673Medicaid
TN3725673Medicaid
TN5198560001Medicare NSC