Provider Demographics
NPI:1770771578
Name:SOUTHERN SURGICAL CONSULTANTS, LLC
Entity type:Organization
Organization Name:SOUTHERN SURGICAL CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-726-9700
Mailing Address - Street 1:1623 NASHVILLE ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-8889
Mailing Address - Country:US
Mailing Address - Phone:270-726-9700
Mailing Address - Fax:270-726-6400
Practice Address - Street 1:1623 NASHVILLE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8889
Practice Address - Country:US
Practice Address - Phone:270-726-9700
Practice Address - Fax:270-726-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-06
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP556208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty