Vicksburg Surgical Associates, PA

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

VICKSBURG SURGICAL ASSOCIATES, PA

Practice address

188 YMCA Place
Vicksburg, MS 39183-3052

Phone

(601) 831-2799

Fax

(601) 629-2723

NPI assigned

Jan 23, 2009

Last updated

Feb 21, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Stephen D Sudderth, M.D.

Title

Owner

Phone

(601) 831-2799

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 4

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.

• Julia Green Varnier, PA-C

  • Physician Assistant
  • Vicksburg, MS
  • NPI 1295766780
  NPD (past)
• Ryne Andrew Graham, PA-C

  • Physician Assistant
  • Beaufort, SC
  • NPI 1619466919
  NPD (past)
• Sandra Phelps, PA-C

  • Physician Assistant
  • Kenner, LA
  • NPI 1013391424
  NPD (past)
• Chesley Williams, PA-C

  • Physician Assistant
  • Roanoke, VA
  • NPI 1548652530
  NPD (past)

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

{
    "created_epoch": "1232668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392940800000",
    "number": "1306084637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 YMCA PLACE",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391833052",
            "telephone_number": "601-831-2799",
            "fax_number": "601-629-2723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 YMCA PLACE",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391833052",
            "telephone_number": "601-831-2799",
            "fax_number": "601-629-2723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICKSBURG SURGICAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-23",
        "last_updated": "2014-02-21",
        "status": "A",
        "authorized_official_last_name": "SUDDERTH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-831-2799",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03081703",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vicksburg Pathology Laboratory
• Vicksburg Primary Care Team Inc
• Vicksburg Special Care Clinic LLC
• Vicksburg Special Care Pharmacy and Compounding LLC (Aspire Rx)
• Vicksburg Spine Center, LLC
• Vicksburg Warren School District
• Vicksburg Women's Care, Inc
• Vine Medical Associates LLC
• Kaila Virgil
• Visions Physical Therapy

• Surgery Physician in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Surgery Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2014; 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.