Provider Demographics
NPI:1366458754
Name:SHELBYVILLE CLINIC CORP
Entity Type:Organization
Organization Name:SHELBYVILLE CLINIC CORP
Other - Org Name:SURGICAL SPECIALTY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHS SR GVP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7000
Mailing Address - Street 1:841 UNION ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:841 UNION ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2610
Practice Address - Country:US
Practice Address - Phone:931-685-0986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELBYVILLE CLINIC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-31
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732391Medicare PIN
TNB02836Medicare UPIN