Provider Demographics
NPI:1497146450
Name:SURGERY CLINIC PA
Entity Type:Organization
Organization Name:SURGERY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:662-534-0890
Mailing Address - Street 1:403 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3110
Mailing Address - Country:US
Mailing Address - Phone:662-534-0890
Mailing Address - Fax:662-534-6754
Practice Address - Street 1:403 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3110
Practice Address - Country:US
Practice Address - Phone:662-534-0890
Practice Address - Fax:662-534-6754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14294174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty