Provider Demographics
NPI:1275064057
Name:SURGICAL SERVICES OF AMERICA, PC
Entity Type:Organization
Organization Name:SURGICAL SERVICES OF AMERICA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:LERRIS
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:615-512-6136
Mailing Address - Street 1:103 FORREST CROSSING BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-5453
Mailing Address - Country:US
Mailing Address - Phone:615-512-6136
Mailing Address - Fax:615-591-5124
Practice Address - Street 1:103 FORREST CROSSING BLVD STE 204
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-5453
Practice Address - Country:US
Practice Address - Phone:615-512-6136
Practice Address - Fax:615-591-5124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000025546208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty