Southern Urology LLC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

SOUTHERN UROLOGY LLC

Practice address

2308 E Main St Ste a
New Iberia, LA 70560-4029

Phone

(337) 408-8676

NPI assigned

Nov 10, 2022

Organization subpart

Yes

Parent organization

SOUTHERN UROLOGY LLCAs reported in NPPES

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

Authorized official

Name

Mark Robert Eldredge

Title

Ao

Phone

(337) 769-7779

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Southern Urology LLC

  • Urology Physician
  • Ville Platte, LA
  • NPI 1346471174

  5597833772

  Same PAC ID
• Southern Urology LLC

  • Urology Physician
  • Opelousas, LA
  • NPI 1386352151

  5597833772

  Same PAC ID
• Southern Urology, LLC

  • Urology Physician
  • Lafayette, LA
  • NPI 1740441955

  5597833772

  Same PAC ID

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

CLIA laboratory certificates

Tax ID family

Southern Urology LLC5 organizations share this tax ID, including this one

Part of

Southern Urology LLC

Other organizations with this tax ID 4

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

• Southern Urology LLC

  • Urology Physician
  • Abbeville, LA
  • NPI 1235846841
  NPD tax ID
• Southern Urology LLC

  • Urology Physician
  • Ville Platte, LA
  • NPI 1346471174
  NPD tax ID
• Southern Urology LLC

  • Urology Physician
  • Opelousas, LA
  • NPI 1386352151
  NPD tax ID
• Southern Urology LLC

  • Urology Physician
  • Crowley, LA
  • NPI 1407564263
  NPD tax ID

Locations

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

{
    "created_epoch": "1668038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712016000000",
    "number": "1104534965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2308 E MAIN ST STE A",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "705604029",
            "telephone_number": "337-408-8676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2308 E MAIN ST STE A",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "705604029",
            "telephone_number": "337-408-8676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN UROLOGY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN UROLOGY LLC",
        "enumeration_date": "2022-11-10",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A",
        "authorized_official_last_name": "ELDREDGE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "337-769-7779"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• South Louisiana Caregiving LLC
• South Louisiana Surgical Association, LLC
• Southern RX
• Southern RX
• Southern Smiles of Iberia, Inc
• Lashanda Lyn Spencer
• Vanessa Nichelle Spencer, MED
• Hyndhavi Srigiriraju, M.D.
• SS Consultant of Louisiana, LLC
• St Michaels Clinic

• Urology Physician in New Iberia, LA
• Providers in New Iberia, LA by specialty
• Urology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; 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.