| Staton Southern Medical, Pllc | |
|
131 Hospital Drive Suite 2000 Carthage TN 37030 | |
| (423) 364-4817 | |
| Not Available |
| Full Name | Staton Southern Medical, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 131 Hospital Drive, Carthage, Tennessee |
| Authorized Official Name and Position | Brent D Staton (PHYSICIAN) |
| Authorized Official Contact | 4236196282 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Staton Southern Medical, Pllc 131 Hospital Drive Suite 2000 Carthage TN 37030 Ph: () - | Staton Southern Medical, Pllc 131 Hospital Drive Suite 2000 Carthage TN 37030 Ph: (423) 364-4817 |
| NPI Number | 1295033595 |
|---|---|
| Provider Enumeration Date | 03/10/2011 |
| Last Update Date | 03/10/2011 |
| Medicare PECOS PAC ID | 9335324193 |
|---|---|
| Medicare Enrollment ID | O20110421000422 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295033595 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Brent D Staton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508989450 PECOS PAC ID: 4789869546 Enrollment ID: I20110421000460 |
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