Organization
SURGICAL SPECIALISTS P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EGBERT REBEIRO M.D (PRESIDENT)
(731) 587-3030
Entity
Organization
Contact information
Practice address
143 KENNEDY DR, SUITE B, MARTIN, TN 38237-3309
(731) 587-3030
Mailing address
143 KENNEDY DR, SUITE B, MARTIN, TN 38237-3309
(731) 587-3030
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD12630
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3727249
—
TN
01
—
4092729
BCBS PROVIDER NUMBER
TN
Enumeration date
06/18/2006
Last updated
10/24/2024
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