Provider Demographics
NPI:1265746978
Name:MILLIGAN SURGICAL CLINIC
Entity type:Organization
Organization Name:MILLIGAN SURGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-787-1940
Mailing Address - Street 1:PO BOX 415000
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37241-0769
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6198
Practice Address - Street 1:49 CLEVELAND ST
Practice Address - Street 2:STE 310
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-9716
Practice Address - Country:US
Practice Address - Phone:931-787-1940
Practice Address - Fax:931-787-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519349Medicaid
TN103G029592Medicare PIN