SOUTHERN SURGERY CENTER, LLC (NPI# 1912906157) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912906157 |
| Entity Type | Organization |
| Organization Name | SOUTHERN SURGERY CENTER, LLC |
| Practice Address |
3688 Veterans Memorial Dr Suite 100 Hattiesburg MS 39401-8246 |
| Practice Telephone | 6015547525 |
| Practice Fax Number | 6015547574 |
| Mailing Telephone | 6015547525 |
| Mailing Fax Number | 6015547574 |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2009-12-28 |
| Authorized Official Name | MR. DAVID M. BURCKEL (CEO) |
| Authorized Official Telephone | 6015547525 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
015 | MS | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | BLUE CROSS & BLUE SHIELD | 000050871 | 01 |
| MS | 00770390 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184083958 | Southern Surgery Center, LLC | Clinic/Center | 605 N Westover Blvd, Albany, GA 31707-2188 | 2016-02-22 |
| 1639179914 | Southern Surgery Center, LLC | Clinic/Center | 1805 Vernon Rd, Suite C, Lagrange, GA 30240-4041 | 2005-07-28 |
| Street Address |
3688 VETERANS MEMORIAL DR SUITE 100 |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39401-8246 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548883200 | Emily Mcdermott | Physical Therapist | 3688 Veterans Memorial Dr, Hattiesburg, MS 39401-8246 | 2020-05-28 |
| 1851924013 | Melissa Ann Ezelle | Registered Nurse | 3688 Veterans Memorial Dr, Hattiesburg, MS 39401-8246 | 2020-02-17 |
| 1932607132 | Kerri Michelle Easterling | Occupational Therapist | 3688 Veterans Memorial Dr, Hattiesburg, MS 39401-8246 | 2018-01-23 |
| 1174980213 | Marshall Bynum | Physician Assistant | 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401-8246 | 2016-01-20 |
| 1487854295 | John J Davis | Specialist/Technologist | 3688 Veterans Memorial Dr, Hattiesburg, MS 39401-8246 | 2007-07-19 |
| 1356546295 | Southern Bone& Joint Specialists | Specialist | 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401-8246 | 2007-06-20 |
| 1295937928 | John Herrington Kosko | Orthopaedic Surgery | 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401-8246 | 2007-06-04 |
| 1952523607 | Frederick O'neal Gregg | Orthopaedic Surgery | 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401 | 2007-05-03 |
| 1912033291 | Sunbelt Rehabilitation Systems, LLC | Clinic/Center | 3688 Veterans Memorial Dr, Suite 300, Hattiesburg, MS 39401-8246 | 2007-02-23 |
| 1538246921 | Benjamin M Yelverton | Physician Assistant | 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401-8246 | 2006-11-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598315863 | Lisa Thornton | Technician | 18 Timberline Dr., Hattiesburg, MS 39401 | 2019-09-18 |
| 1548813637 | Caroline Estes Barnes | Counselor | Barnes, 8 App Slade Road, Hattiesburg, MS 39401 | 2019-07-18 |
| 1396252441 | Selection Healthcare Services, LLC | In Home Supportive Care | 606 Adeline St Ste 1c, Hattiesburg, MS 39401 | 2018-01-10 |
| 1225545585 | Whitney Wilkinson | Nurse Practitioner | 301 South 28th Avenue, Hattiesburg, MS 39401 | 2018-01-08 |
| 1740795806 | Forrest General Hospital | Pharmacy | 1414 South 28th Avenue, Hattiesburg, MS 39401 | 2017-12-11 |
| 1275058455 | Casey Payne | Pharmacist | 6130 Us 49, Hattiesburg, MS 39401 | 2017-08-08 |
| 1225562705 | Sarah Marie Hudson | Family Medicine | 6051 Us Highway 49 S, Hattiesburg, MS 39401 | 2017-04-12 |
| 1043671704 | The Covington's Cove Assisted Living Center LLC | Assisted Living Facility | 192 Mary Magdalene Church Rd, Hattiesburg, MS 39401 | 2016-03-09 |
| 1780083626 | Dominique Reed Watson | Pharmacist | 602 Adeline St, Hattiesburg, MS 39401 | 2014-08-15 |
| 1558778936 | Willie Davis Jr. | Day Training, Developmentally Disabled Services | 701 Duke Ave., Hattiesbiurg, MS 39401 | 2014-07-17 |
| Find all providers in zip 39401 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629300512 | Bellevue Surgery Center, LLC | Clinic/Center | 7125 Highway 98, Bellevue Surgery Center, LLC, Hattiesburg, MS 39402 | 2010-02-03 |
| 1922011501 | Lowery A. Woodall Outpatient Surgery Facility, LLC | Clinic/Center | 105 S 28th Ave, Hattiesburg, MS 39401-7152 | 2006-08-14 |
| 1538776679 | Hattiesburg Clinic, Pa | Clinic/Center | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2020-09-23 |
| 1023343720 | Hattiesburg Surgery Center, LLC | Clinic/Center | 139 Fairfield Drive, Hattiesburg, MS 39402 | 2009-10-14 |
| 1578898276 | Southern Urology Surgery Center, LLC | Clinic/Center | 139 Fairfield Drive, Hattiesburg, MS 39402 | 2009-10-14 |
| 1528206141 | Hattiesburg Eye Clinic Cataract & Lasik Surgery Center, LLC | Clinic/Center | 103 Millsaps Dr, Hattiesburg, MS 39402-1348 | 2009-02-04 |
| 1811144348 | Southern Eye Center P.a. II | Clinic/Center | 1420 S 28th Ave, Hattiesburg, MS 39402-3107 | 2008-08-27 |
| 1417112277 | Southern Eye Surgery Center LLC | Clinic/Center | 1420 S 28th Ave, Hattiesburg, MS 39402-3107 | 2008-07-22 |
| 1962688358 | Psch, LLC | Clinic/Center | 40 Franklin Rd, Hattiesburg, MS 39402-1318 | 2008-01-15 |
| 1508933797 | Head and Neck Surgery Center, LLC | Clinic/Center | 107 Millsaps Dr, Hattiesburg, MS 39402-1348 | 2006-11-30 |
| Find all providers in HATTIESBURG | ||||
| City | HATTIESBURG |
| Zip Code | 39401 |
Please comment or provide details below to improve the information on SOUTHERN SURGERY CENTER, LLC.
| 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.