Organization
SURGERY CLINIC OF TUPELO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERECIA SPAIN (CLINIC ADMINISTRATOR)
(662) 377-6472
Entity
Organization
Contact information
Practice address
499 GLOSTER CREEK VLG STE S1, TUPELO, MS 38801-4708
(662) 377-6470
(662) 377-6475
Mailing address
454 E PRESIDENT AVE, TUPELO, MS 38801-5501
(662) 377-6470
(662) 377-6475
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013129
—
MS
Enumeration date
01/27/2006
Last updated
12/14/2018
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