Southern Sports Surgical, LLC.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SOUTHERN SPORTS SURGICAL, LLC.

Doing business as

Indian Lake Surgery Center

Practice address

127 Saundersville Rd.
Suite a
Hendersonville, TN 37075-8902

Phone

(615) 265-8038

Fax

(615) 265-8546

NPI assigned

Feb 10, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Gautsch, M.D.

Title

Ceo

Phone

(615) 418-2975

Specialties & licenses 1

Addresses

Other names 1

• Indian Lake Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Listed as

Southern Sports Surgical LLC Dba Indian Lake Surgery CenterCCN 44C0001188

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1391990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408406400000",
    "number": "1558785683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 SAUNDERSVILLE RD.",
            "address_2": "SUITE A",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370758902",
            "telephone_number": "615-265-8038",
            "fax_number": "615-265-8546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 SAUNDERSVILLE RD.",
            "address_2": "SUITE A",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370758902",
            "telephone_number": "615-265-8038",
            "fax_number": "615-265-8546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN SPORTS SURGICAL, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-10",
        "last_updated": "2014-08-19",
        "status": "A",
        "authorized_official_last_name": "GAUTSCH",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-418-2975",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Lake Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexandra Souksangouane
• Kelley B. Southard, P.T.
• Southern Care Providers LLC
• Southern Medical
• Southern Medical
• Haleigh Southern, FNP
• Clyde O Southwell, MD
• David Parker Sparks, MD
• Keita Spaulding, DMD
• Caroline Spears

• Ambulatory Surgical Clinic/Center in Hendersonville, TN
• Providers in Hendersonville, TN by specialty
• Ambulatory Surgical Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2014; 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.