Provider Demographics
NPI:1013938026
Name:SURGICAL SPECIALISTS PLLC
Entity type:Organization
Organization Name:SURGICAL SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNABB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-479-9647
Mailing Address - Street 1:2301 N OCOEE STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311
Mailing Address - Country:US
Mailing Address - Phone:423-479-9647
Mailing Address - Fax:423-479-2216
Practice Address - Street 1:2301 N OCOEE ST
Practice Address - Street 2:SUITE B
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3863
Practice Address - Country:US
Practice Address - Phone:423-479-9647
Practice Address - Fax:423-479-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3705120Medicare ID - Type Unspecified