Provider Demographics
NPI:1396427241
Name:SOUTHERN VASCULAR AND PAIN SURGERY CENTER LLC
Entity type:Organization
Organization Name:SOUTHERN VASCULAR AND PAIN SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:HODGKISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-350-0978
Mailing Address - Street 1:921 DENT RD
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-9704
Mailing Address - Country:US
Mailing Address - Phone:901-350-0978
Mailing Address - Fax:901-350-0677
Practice Address - Street 1:221 MAIN ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:KY
Practice Address - Zip Code:42041-1601
Practice Address - Country:US
Practice Address - Phone:901-350-0978
Practice Address - Fax:901-350-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty