Southern Surgical Group, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

186449 Issued in SC

Legal business name

SOUTHERN SURGICAL GROUP, LLC

Practice address

3600 Sea Mountain Hwy Suite a
Little River, SC 29566

Phone

(843) 399-9095

Fax

(843) 399-9098

NPI assigned

Sep 3, 2013

Organization subpart

No

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

Authorized official

Name

Trevor Ward Poole

Title

M.D

Phone

(843) 399-9095

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1378166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378166400000",
    "number": "1376977884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 SEA MOUNTAIN HWY SUITE A",
            "city": "LITTLE RIVER",
            "state": "SC",
            "postal_code": "29566",
            "telephone_number": "843-399-9095",
            "fax_number": "843-399-9098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 SEA MOUNTAIN HWY SUITE A",
            "city": "LITTLE RIVER",
            "state": "SC",
            "postal_code": "29566",
            "telephone_number": "843-399-9095",
            "fax_number": "843-399-9098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN SURGICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-03",
        "last_updated": "2013-09-03",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_middle_name": "WARD",
        "authorized_official_title_or_position": "M.D",
        "authorized_official_telephone_number": "843-399-9095"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "SC",
            "license": "186449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1891743159",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Carolina Em-1 Medical Services, PC
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• South Carolina Podiatric Physicians and Surgeons Group, LLC
• Southern Spinal Care, PC
• Southern Surgical Group, LLC
• Southern Surgical, PA
• Cathy Sparacia
• Olinda P. Spencer, M.D.
• Samantha Electra Spencer
• Sarah Spencer, DDS

• Specialist in Little River, SC
• Providers in Little River, SC by specialty
• Specialist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2013; 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.