Provider Demographics
NPI:1740471572
Name:NORTH MADISON SURGICAL GROUP
Entity type:Organization
Organization Name:NORTH MADISON SURGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-936-3102
Mailing Address - Street 1:1421 E PEACE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-4938
Mailing Address - Country:US
Mailing Address - Phone:601-859-5323
Mailing Address - Fax:601-859-3730
Practice Address - Street 1:1421 E PEACE ST
Practice Address - Street 2:SUITE B
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4938
Practice Address - Country:US
Practice Address - Phone:601-859-5323
Practice Address - Fax:601-859-3730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADISON COUNTY HMA PHYSICIAN MGT. SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC03614Medicare PIN