Southern Endoscopy Suite, LLC

Primary specialty

Endoscopy Clinic/CenterTaxonomy code 261QE0800X

License

067-200 Issued in GA

Legal business name

SOUTHERN ENDOSCOPY SUITE, LLC

Practice address

763 Old Norcross Rd
Lawrenceville, GA 30045-4317

Phone

(678) 985-2000

Fax

(678) 985-1999

NPI assigned

May 10, 2006

Organization subpart

No

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

Authorized official

Name

Mark B. Kukler, D.O.,NPI 1093765265

Title

Owner

Phone

(678) 985-2000

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

Southern Endoscopy Suite LLCCCN 11C0001174

Medicare certification status

ActiveFrom the Provider of Services file

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark B. Kukler, D.O.

  • Gastroenterology Physician
  • Lawrenceville, GA
  • NPI 1093765265
  NPD Authorized official

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511827200000",
    "number": "1215986609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "763 OLD NORCROSS RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300454317",
            "telephone_number": "678-985-2000",
            "fax_number": "678-985-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "763 OLD NORCROSS RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300454317",
            "telephone_number": "678-985-2000",
            "fax_number": "678-985-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ENDOSCOPY SUITE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2017-11-28",
        "status": "A",
        "authorized_official_last_name": "KUKLER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-985-2000",
        "authorized_official_credential": "D.O.,"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": "GA",
            "license": "067-200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria B. Soto, M.D.
• Soulcare Health, LLC
• Southern Charm Anesthesia Associates
• Southern Clinical Laboratory Inc.
• Southern Dermatology PC
• Southern Gastroenterology Associates, LLC
• Southern Sky Outpatient Detox, LLC
• Southern Smiles Lawrenceville PC
• Southern Surgical Associates, PC
• Southside Medical Center, Inc

• Endoscopy Clinic/Center in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Endoscopy Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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.