Provider Demographics
NPI:1861655599
Name:METHODIST SPECIALTY PHYSICIAN, V, LLC
Entity Type:Organization
Organization Name:METHODIST SPECIALTY PHYSICIAN, V, LLC
Other - Org Name:MCGEE GENERAL SURGERY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PRACTICE DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-516-0843
Mailing Address - Street 1:214 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-9737
Mailing Address - Country:US
Mailing Address - Phone:901-465-3604
Mailing Address - Fax:901-465-4576
Practice Address - Street 1:214 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-9737
Practice Address - Country:US
Practice Address - Phone:901-465-3604
Practice Address - Fax:901-465-4576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44014174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty