Urologic Ambulatory Surgery Center, LLC
Organization Active NPI Ambulatory Surgical Clinic/Center · Tupelo, MS
NPI 1154867562 · NPPES record last updated Oct 24, 2023
Key facts
- NPI
- 1154867562
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- Legal business name
- UROLOGIC AMBULATORY SURGERY CENTER, LLC
- Practice address
- 499 Gloster Creek VLG Ste B8
Tupelo, MS 38801-4633 - Phone
- (662) 432-0700
- Fax
- (662) 846-0566
- NPI assigned
- Jan 9, 2017
- Organization subpart
- No
Authorized official
- Name
- Mrs. Deonne Henry
- Title
- Director of Operations
- Phone
- (662) 432-0700
Member organizations 1
Practitioners 7
-
Paul Farabaugh, MD
-
Jonathan Kalish, MD
-
Jon T Posey, MD
Medicare Care Compare: Ambulatory surgical center
- Listed as
- Urologic Ambulatory Surgery Center
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2136876 | Urologic Ambulatory Surgery Center LLC | Certificate of waiver | Sep 17, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170601000339 | MS | Part B Supplier - Ambulatory Surgical Center | 4688941396 |
Receives reassigned benefits from 7 practitioners Practice locations: Tupelo, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician |
208800000X | |||
| Ambulatory Surgical Clinic/Center | 261QA1903X | Yes |
Addresses
Primary practice location
499 Gloster Creek VLG Ste B8
Tupelo, MS 38801-4633
Mailing address
PO Box 829
Tupelo, MS 38802-0829
Phone (662) 377-7100
Other providers in Tupelo, MS
- United Methodist Senior Services Health Care, Inc
- Unity Hospice Care, LLC
- Universal Medical Supplies & Rentals Inc
- Urgent Specialty Associates of Mississippi PLLC
- Urgent Specialty Associates of Mississippi PLLC
- Urologic Reference Lab LLC
- Urology Professional Association
- Austin Urvina
- US Land Cruiser Non Profit Public Trans., Inc.
- Rana Muhammad Usman
All providers in Tupelo, MS · Ambulatory Surgical Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.