Basic Information
Provider Information
NPI: 1316296205
EntityType: 2
ReplacementNPI:  
OrganizationName: SOUTHERN TIER SURGICAL PLLC
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Mailing Information
Address1: 30 HARRISON STREET
Address2: SUITE 320
City: JOHNSON CITY
State: NY
PostalCode: 137902162
CountryCode: US
TelephoneNumber: 6077638205
FaxNumber: 6077638208
Practice Location
Address1: 30 HARRISON STREET
Address2: SUITE 320
City: JOHNSON CITY
State: NY
PostalCode: 137902162
CountryCode: US
TelephoneNumber: 6077638205
FaxNumber: 6077638208
Other Information
ProviderEnumerationDate: 09/06/2012
LastUpdateDate: 02/11/2013
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AuthorizedOfficialLastName: TVETENSTRAND
AuthorizedOfficialFirstName: CHRISTIAN
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AuthorizedOfficialTitleorPosition: SURGEON
AuthorizedOfficialTelephone: 6077638205
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X178438NYY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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