NPIMap

Organization Active NPI

Southside Surgical Specialists PC

  • Surgery Physician
  • Danville, VA
National Provider Identifier
1619068673
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
0101232606 Issued in VA
Legal business name
SOUTHSIDE SURGICAL SPECIALISTS PC
Practice address
159 Executive Dr Ste B
Danville, VA 24541-4160
Phone
(434) 792-5964
Fax
(434) 792-5971
NPI assigned
Sep 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Mrs. Joan C Martin
Title
Office Manager
Phone
(434) 792-5964

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 0101232606 VA Primary

Addresses

Primary practice location

159 Executive Dr Ste B
Danville, VA 24541-4160

Mailing address

159 Executive Dr Ste B
Danville, VA 24541-4160
Phone (434) 792-5964

Other identifiers 4

IdentifierTypeStateIssuer
010151163MedicaidVA
007308345MedicaidVA
7312580MedicaidVA
007300107MedicaidVA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1619068673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 EXECUTIVE DR STE B",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245414160",
            "telephone_number": "434-792-5964",
            "fax_number": "434-792-5971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 EXECUTIVE DR STE B",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245414160",
            "telephone_number": "434-792-5964",
            "fax_number": "434-792-5971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE SURGICAL SPECIALISTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "434-792-5964",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101232606",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010151163",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007308345",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7312580",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007300107",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.