Organization
THE NEUROSURGICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WINSTON CRAIG CLARK M.D. (OWNER)
(662) 349-5660
Entity
Organization
Contact information
Practice address
55 PHYSICIANS LN, SUITE 1, SOUTHAVEN, MS 38671-9569
(662) 349-5660
(662) 349-5669
Mailing address
55 PHYSICIANS LN, SUITE 1, SOUTHAVEN, MS 38671-9569
(662) 349-5660
(662) 349-5669
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
MD14839
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07659397
—
MS
01
—
162898
BCBS OF TN
TN
01
—
257741290
BCBS OF MS
MS
05
—
3707531
—
TN
Enumeration date
09/26/2006
Last updated
02/18/2009
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