ST. JOSEPH'S VASCULAR GROUP, LLC (NPI# 1164829883) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164829883 |
| Entity Type | Organization |
| Organization Name | ST. JOSEPH'S VASCULAR GROUP, LLC |
| Practice Address |
11909 Mcauley Drive Suite 100 A2 Savannah GA 31419 |
| Mailing Address |
836 E. 65th Street Suite 22 Savannah GA 31405 |
| Practice Telephone | 9129548331 |
| Practice Fax Number | 9123529782 |
| Mailing Telephone | 9128197878 |
| Mailing Fax Number | 9128193320 |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2020-04-24 |
| Authorized Official Name | PAUL P. HUNCHEY (PRESIDENT/CEO) |
| Authorized Official Telephone | 9128196901 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians |
| Street Address |
11909 MCAULEY DRIVE SUITE 100 A2 |
| City | SAVANNAH |
| State | GA |
| Zip Code | 31419 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538197355 | Norman Lee Yates IIi | Surgery | 11909 Mcauley Drive, Suite 100 A2, Savannah, GA 31419 | 2006-06-29 |
| 1023502903 | Angela Marie Hinely | Nurse Practitioner | 11909 Mcauley Drive, Suite 100 A2, Savannah, GA 31419 | 2018-06-14 |
| 1720471519 | Stacy Crawford | Registered Nurse | 11909 Mcauley Drive, Suite 100 A2, Savannah, GA 31419 | 2015-03-18 |
| 1982924502 | Kristy Michelle Wiebke | Surgery | 11909 Mcauley Drive, Suite 100 A2, Savannah, GA 31419 | 2010-06-05 |
| 1841459401 | Peter James Hunt | Surgery | 11909 Mcauley Drive, Suite 100 A2, Savannah, GA 31419 | 2008-06-08 |
| 1003083072 | Savannah Bone and Joint, P.C. | Specialist | 11909 Mcauley Drive, Suite 100 A2, Savannah, GA 31419-1794 | 2008-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255932653 | Loving Hands Adult Care | Home Health Aide | 101 St. Goerge Blvd, 6t, Savannah, GA 31419 | 2020-11-03 |
| 1285241265 | Jennifer Ann Hales | Surgery | 11090 Mcauley, Suite 100 2a, Savannah, GA 31419 | 2020-09-24 |
| 1699318139 | Jessica Kaitlyn Matthewson | Nurse Practitioner | 11700 Mercy Blvd Plaza D, Bldg #5, Savannah, GA 31419 | 2019-10-28 |
| 1679133219 | Rebecca Denise Brown-tuyishimire | Counselor | Savannah Outpatient Clinic, 1170 Shawnee Street, Savannah, GA 31419 | 2019-06-17 |
| 1356900856 | Julio Roberto Castellanos Jr. | Behavior Technician | 785 King George Blvd Ste 103, Savannah, GA 31419 | 2019-06-07 |
| 1669941761 | Paul-david Arthur Cooper | Peer Specialist | 117 Shawnee Street, Va Savannah Clinic, Savannah, GA 31419 | 2018-11-19 |
| 1326538521 | Jay Carter Jr. | Social Worker | 1170 Shawnee St., Savannah, GA 31419 | 2018-05-14 |
| 1245771070 | Emily Robertson | Nurse Practitioner | 11133 Abercorm Street, Suite 10, Savannah, GA 31419 | 2017-03-13 |
| 1760833750 | Cady-jo Steidle | Behavioral Analyst | 143 Sugar Mill Cir, Savannah, GA 31419 | 2016-06-30 |
| 1265881189 | Mallory Williams | Physician Assistant | 11909 D. Mcauley Drive, Savannah, GA 31419 | 2016-06-10 |
| Find all providers in zip 31419 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285241265 | Jennifer Ann Hales | Surgery | 11090 Mcauley, Suite 100 2a, Savannah, GA 31419 | 2020-09-24 |
| 1023517505 | Antioch Vascular Center, LLC | Surgery | 9104 Middleground Road, Suite 2, Savannah, GA 31406 | 2018-02-09 |
| 1114924677 | Michael Steven Dahn | Surgery | 4750 Waters Ave Ste 500, Savannah, GA 31404-6261 | 2005-06-30 |
| 1528326667 | Gregory Taylor Ellison Jr. | Surgery | 4750 Waters Ave Ste 500, Savannah, GA 31404 | 2012-04-26 |
| 1528365723 | Justin B Brown | Surgery | 4750 Waters Ave Ste 500, Savannah, GA 31404 | 2011-02-24 |
| 1396076162 | Coastal Vein Solutions LLC | Surgery | 11550 Abercorn St, Savannah, GA 31419-1902 | 2010-01-19 |
| 1043455306 | Davis Sungwhan Moon | Surgery | 4750 Waters Ave Ste 500, Savannah, GA 31404-6261 | 2008-12-15 |
| 1043247232 | Edward J Cohn Jr. | Surgery | 4750 Waters Ave, Suite 500, Savannah, GA 31404 | 2006-06-26 |
| 1306873518 | Anthony M. Sussman | Surgery | 4750 Waters Ave, Suite 500, Savannah, GA 31404-6200 | 2006-06-26 |
| 1407882582 | Christopher L. Wixon | Surgery | 4750 Waters Ave, Suite 500, Savannah, GA 31404-6200 | 2006-06-23 |
| Find all providers in SAVANNAH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.