Provider Demographics
NPI:1811941396
Name:MID-SOUTH SURGICAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:MID-SOUTH SURGICAL ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CLARKE
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-624-5233
Mailing Address - Street 1:2108 E 3RD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2605
Mailing Address - Country:US
Mailing Address - Phone:423-624-5233
Mailing Address - Fax:423-624-4440
Practice Address - Street 1:2108 E 3RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2605
Practice Address - Country:US
Practice Address - Phone:423-624-5233
Practice Address - Fax:423-624-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709850Medicare ID - Type UnspecifiedGROUP MEDICARE