Provider Demographics
NPI:1235247586
Name:MID-STATE SURGERY PLLC
Entity Type:Organization
Organization Name:MID-STATE SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:AKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-904-0244
Mailing Address - Street 1:1800 MEDICAL CENTER PARKWAY
Mailing Address - Street 2:SUITE 430
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:615-904-0244
Mailing Address - Fax:615-904-1848
Practice Address - Street 1:1800 MEDICAL CENTER PARKWAY
Practice Address - Street 2:SUITE 430
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-904-0244
Practice Address - Fax:615-904-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3711437Medicaid
TN3711437Medicaid