ENT of South Georgia Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

ENT OF SOUTH GEORGIA SURGERY CENTER LLC

Practice address

2805 N Oak St
Valdosta, GA 31602-5922

Phone

(229) 244-2562

Fax

(229) 249-0000

NPI assigned

May 12, 2016

Last updated

May 3, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

EAR, NOSE, THROAT AND ALLERGY ASSOCIATES OF SOUTH GEORGIA PCAs reported in NPPES

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

Authorized official

Name

Dr. Ronald V AllenNPI 1831162049

Title

President

Phone

(229) 244-2562

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

ENT of Sourth Georgia Surgery CenterCCN 11C0001461

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

ENT Allergy Assoc of S

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Ear, Nose, Throat, and Allergy Associates of South Georgia PC

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Valdosta, GA
  • NPI 1629086327
  NPPES parent name

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ronald V Allen, MD

  • Otolaryngology Physician
  • Valdosta, GA
  • NPI 1831162049
  NPD (past) Authorized official
• Theodore J Kanne, MD

  • Otolaryngology Physician
  • Valdosta, GA
  • NPI 1528030806
  NPD (past)
• Thomas E Phillips, MD

  • Otolaryngology Physician
  • Valdosta, GA
  • NPI 1033181318
  NPD (past)

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

{
    "created_epoch": "1463011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493769600000",
    "number": "1104272780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316025922",
            "telephone_number": "229-244-2562",
            "fax_number": "229-249-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316025922",
            "telephone_number": "229-244-2562",
            "fax_number": "229-249-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENT OF SOUTH GEORGIA SURGERY CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAR, NOSE, THROAT AND ALLERGY ASSOCIATES OF SOUTH GEORGIA PC",
        "enumeration_date": "2016-05-12",
        "last_updated": "2017-05-03",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "229-244-2562",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000834589A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000946668A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000655146A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.