1093131211 NPI number — STOKES SURGERY GROUP, PC

Table of content: (NPI 1093131211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093131211 NPI number — STOKES SURGERY GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STOKES SURGERY GROUP, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093131211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1562
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLIERVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38027-1562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-484-8128
Provider Business Mailing Address Fax Number:
901-328-5599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1143 CULLY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORDOVA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38018-8502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-484-8128
Provider Business Practice Location Address Fax Number:
901-328-5599
Provider Enumeration Date:
03/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
STOKES
Authorized Official First Name:
MYRON
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
615-715-9094

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03431013 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q005388 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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