NPIMap

Organization Active NPI

Southland Optim Screven Emergency Medical Services LLC

  • Emergency Medicine Physician
  • Sylvania, GA
National Provider Identifier
1174917157
Registry record updated Mar 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
SOUTHLAND OPTIM SCREVEN EMERGENCY MEDICAL SERVICES LLC
Practice address
215 Mims Rd
Sylvania, GA 30467-1994
Phone
(229) 236-0831
Fax
(229) 236-0871
NPI assigned
Mar 27, 2015
Last updated
Mar 27, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2015

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

Authorized official

Name
Stephanie Fletcher
Title
Cfo
Phone
(229) 520-7115

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Primary

Addresses

Primary practice location

215 Mims Rd
Sylvania, GA 30467-1994

Mailing address

100 S Madison St
Thomasville, GA 31792-5473
Phone (229) 236-0831

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151210000476 GA Part B Supplier - Clinic/Group Practice 9739480021 Receives reassigned benefits from 65 practitioners
Practice locations: Reidsville, GA; Sylvania, GA; Hazlehurst, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 65

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.

View all 65

NPI Registry JSON

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

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427414400000",
    "number": "1174917157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S MADISON ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925473",
            "telephone_number": "229-236-0831",
            "fax_number": "229-236-0871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 MIMS RD",
            "city": "SYLVANIA",
            "state": "GA",
            "postal_code": "304671994",
            "telephone_number": "229-236-0831",
            "fax_number": "229-236-0871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND OPTIM SCREVEN EMERGENCY MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-27",
        "last_updated": "2015-03-27",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "229-520-7115"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sylvania, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.