Provider Demographics
NPI:1275723595
Name:ANDREW W. SISK, MD, FACS
Entity Type:Organization
Organization Name:ANDREW W. SISK, MD, FACS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:W
Authorized Official - Last Name:SISK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-381-4976
Mailing Address - Street 1:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38402-0317
Mailing Address - Country:US
Mailing Address - Phone:931-381-4976
Mailing Address - Fax:931-388-0600
Practice Address - Street 1:1223 TROTWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4854
Practice Address - Country:US
Practice Address - Phone:931-381-4976
Practice Address - Fax:931-388-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN007326208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0020839OtherBLUE CROSS OF TENNESSEE
TN3724251Medicare PIN