Provider Demographics
NPI:1609806355
Name:HUNTINGDON SURGICAL P.C
Entity Type:Organization
Organization Name:HUNTINGDON SURGICAL P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CALPHOR
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-986-8623
Mailing Address - Street 1:641 RB WILSON DR STE J
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-1734
Mailing Address - Country:US
Mailing Address - Phone:731-986-8623
Mailing Address - Fax:731-986-8625
Practice Address - Street 1:641 RB WILSON DR STE J
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-1734
Practice Address - Country:US
Practice Address - Phone:731-986-8623
Practice Address - Fax:731-986-8625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38761174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3726020Medicaid
TN3726020Medicare PIN
TN3726020Medicaid