NPIMap

Organization Active NPI

Tylertown Surgical Associates

  • Clinic/Center
  • Tylertown, MS
National Provider Identifier
1114030129
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
07415 Issued in MS
Legal business name
TYLERTOWN SURGICAL ASSOCIATES
Practice address
250 Hospital Dr
Tylertown, MS 39667-2020
Phone
(601) 876-4961
Fax
(601) 876-9172
NPI assigned
Aug 16, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Posavanike S Ganaraj, M.D.NPI 1003996281
Title
President
Phone
(601) 876-4961

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 07415 MS Primary

Addresses

Primary practice location

250 Hospital Dr
Tylertown, MS 39667-2020

Mailing address

250 Hospital Dr
P.0. Box 465
Tylertown, MS 39667-2020
Phone (601) 876-4961

Other identifiers 1

IdentifierTypeStateIssuer
09016259MedicaidMS

National Provider Directory

National Provider Directory

Locations

250 Hospital Dr
Tylertown, MS 39667
Phone (601) 876-4961

250 Hospital Dr
#P0
Tylertown, MS 39667

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114030129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 HOSPITAL DR",
            "address_2": "P.0. BOX 465",
            "city": "TYLERTOWN",
            "state": "MS",
            "postal_code": "396672020",
            "telephone_number": "601-876-4961",
            "fax_number": "601-876-9172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 HOSPITAL DR",
            "city": "TYLERTOWN",
            "state": "MS",
            "postal_code": "396672020",
            "telephone_number": "601-876-4961",
            "fax_number": "601-876-9172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYLERTOWN SURGICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GANARAJ",
        "authorized_official_first_name": "POSAVANIKE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-876-4961",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MS",
            "license": "07415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09016259",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tylertown, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.