NPIMap

Organization Active NPI

Southeast Urogyn LLC

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Jackson, MS
National Provider Identifier
1548513617
Registry record updated Jan 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X
Legal business name
SOUTHEAST UROGYN LLC
Practice address
501 Marshall St
Suite 600
Jackson, MS 39202-1651
Phone
(601) 948-6540
Fax
(601) 326-1501
NPI assigned
Oct 26, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2016

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

Authorized official

Name
Mrs. Julie Ferguson
Title
Administrator
Phone
(601) 948-6540

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207V00000X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207VF0040X Primary

Addresses

Primary practice location

501 Marshall St
Suite 600
Jackson, MS 39202-1651

Mailing address

501 Marshall St
Suite 600
Jackson, MS 39202-1651
Phone (601) 948-6540

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140310001027 MS Part B Supplier - Clinic/Group Practice 7517197718 Receives reassigned benefits from 11 practitioners
Practice locations: Columbus, MS; Flowood, MS; Madison, MS

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

885 Liberty Rd
Ste 500
Flowood, MS 39232
Phone (251) 605-9727

501 Marshall St
Ste 600C
Jackson, MS 39202

160 Fountains Blvd
Madison, MS 39110
Phone (601) 714-1025

111 Colony Crossing Way
Ste 230
Madison, MS 39110
Phone (601) 326-6401

160 Fountains Blvd
Ste B
Madison, MS 39110
Phone (601) 898-7500

111 Colony Crossing Way
Ste 250
Madison, MS 39110
Phone (601) 326-6401

1800 12th St
Ste 48
Meridian, MS 39301

1800 12th St
Ste 4B
Meridian, MS 39301
Phone (800) 696-7059

5002 Highway 39 N
Meridian, MS 39301
Phone (601) 693-7742

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1351209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453248000000",
    "number": "1548513617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 MARSHALL ST",
            "address_2": "SUITE 600",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021651",
            "telephone_number": "601-948-6540",
            "fax_number": "601-326-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 MARSHALL ST",
            "address_2": "SUITE 600",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021651",
            "telephone_number": "601-948-6540",
            "fax_number": "601-326-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST UROGYN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-26",
        "last_updated": "2016-01-20",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-948-6540",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2016; 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.