NPIMap

Organization Active NPI

Provident Health Surgical Associates, Inc.

  • Surgery Physician
  • Savannah, GA
National Provider Identifier
1104113307
Registry record updated Jul 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
PROVIDENT HEALTH SURGICAL ASSOCIATES, INC.
Doing business as
ACI Surgical Associates
Practice address
4700 Waters Ave
Suite 405
Savannah, GA 31404-6220
Phone
(912) 350-2700
Fax
(912) 350-2715
NPI assigned
Jul 8, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Robin J. Maddox
Title
Provider Enrollment Coordinator
Phone
(912) 350-9335

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

4700 Waters Ave
Suite 405
Savannah, GA 31404-6220

Mailing address

4700 Waters Ave
Suite 405
Savannah, GA 31404-6220
Phone (912) 350-2700

Other names 1

  • ACI Surgical Associates Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Aci Surgical Associates5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1310083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310083200000",
    "number": "1104113307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 WATERS AVE",
            "address_2": "SUITE 405",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314046220",
            "telephone_number": "912-350-2700",
            "fax_number": "912-350-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 WATERS AVE",
            "address_2": "SUITE 405",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314046220",
            "telephone_number": "912-350-2700",
            "fax_number": "912-350-2715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT HEALTH SURGICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-08",
        "last_updated": "2011-07-08",
        "status": "A",
        "authorized_official_last_name": "MADDOX",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT COORDINATOR",
        "authorized_official_telephone_number": "912-350-9335",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ACI Surgical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.