Paris Surgical Specialists, P.L.L.C.
Organization Active NPI Surgery Physician · Paris, TN
NPI 1790701654 · NPPES record last updated Nov 5, 2007
Key facts
- NPI
- 1790701654
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Surgery Physician 208600000X
- Legal business name
- PARIS SURGICAL SPECIALISTS, P.L.L.C.
- Practice address
- 235 Tyson Ave
Paris, TN 38242-4544 - Phone
- (731) 644-3211
- Fax
- (731) 644-1552
- NPI assigned
- Jul 14, 2006
- Organization subpart
- No
Authorized official
- Name
- Stacia Lynn Puckett
- Title
- Office Manager
- Phone
- (731) 644-3211
Practitioners 4
-
Amy P Boyd, M.D.
-
Russell Wayne Boyd, M. D.
-
Jason Louis Harper, M.D.
-
Andrew Hayward Lundberg, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040401000540 | TN | Part B Supplier - Clinic/Group Practice | 3274525092 |
Receives reassigned benefits from 4 practitioners Practice locations: Paris, TN; Union City, TN |
National Provider Directory
Locations
235 Tyson Ave
Paris, TN 38242
Phone (731) 644-3211
300 Hospital Cir
Ste 300
Paris, TN 38242
Phone (731) 644-3211
1010 Wayne Rd
Ste 204
Savannah, TN 38372
Phone (731) 644-3211
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician |
207L00000X | |||
| Surgery Physician |
208600000X | Yes | ||
| Vascular Surgery Physician |
2086S0129X |
Addresses
Primary practice location
235 Tyson Ave
Paris, TN 38242-4544
Mailing address
235 Tyson Ave
Paris, TN 38242-4544
Phone (731) 644-3211
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DB4003 | Other | TN | RAILROAD MEDICARE GROUP |
Other providers in Paris, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.