PLATEAU ORAL SURGERY, PC; NPI #1730407560

Contact Information

PLATEAU ORAL SURGERY, PC

920 S WILLOW AVE
COOKEVILLE, TN 38501-4150

Phone: 931-525-6059
Fax: 931-525-6079
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Oral and Maxillofacial Surgery	261QS0112X

Indicates primary specialty

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NPI Profile & details for PLATEAU ORAL SURGERY, PC

NPI # 1730407560

LBN Legal business name PLATEAU ORAL SURGERY, PC

Authorized official NANCY KELLY - (INSURANCE COORDINATOR)

Entity Organization

Organization subpart ¹ No

Enumeration date 05/04/2010

Last updated 06/20/2018 - About 8 years ago

Identifiers

TN	License #	D57545
TN	Medicaid	3226373

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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