Active NPI
Southern Urology Associates LLC
Doing business as Southern Urology Associates
- Urology Physician
- Gulfport, MS
National Provider Identifier
1619919917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- Legal business name
- SOUTHERN UROLOGY ASSOCIATES LLC
- Doing business as
- Southern Urology Associates
- Practice address
- 15190 Community Rd
Suite 260
Gulfport, MS 39503-3485 - Phone
- (228) 539-0071
- Fax
- (228) 539-0722
- NPI assigned
- Jun 12, 2006
- Last updated
- Jun 21, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert J. Lageese
- Title
- VP
- Phone
- (504) 988-7044
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | NU | Primary |
Addresses
Primary practice location
15190 Community Rd
Suite 260
Gulfport, MS 39503-3485
Mailing address
15190 Community Rd
Suite 260
Gulfport, MS 39503-3485
Phone (228) 539-0071
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275576 | Medicaid | MS |
Other names 1
- Southern Urology Associates
National Provider Directory
National Provider Directory- Tax ID family
- Southern Urology Assoc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Urology Physician
- Gulfport, MS
- NPI 1962557157
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1529539200000",
"number": "1619919917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15190 COMMUNITY RD",
"address_2": "SUITE 260",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395033485",
"telephone_number": "228-539-0071",
"fax_number": "228-539-0722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15190 COMMUNITY RD",
"address_2": "SUITE 260",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395033485",
"telephone_number": "228-539-0071",
"fax_number": "228-539-0722"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHERN UROLOGY ASSOCIATES LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-12",
"last_updated": "2018-06-21",
"status": "A",
"authorized_official_last_name": "LAGEESE",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "J.",
"authorized_official_title_or_position": "VP",
"authorized_official_telephone_number": "504-988-7044"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1275576",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Southern Urology Associates",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Gulfport, MS
- Southern Neuro Solutions
- Southern Nights, LLC
- Southern Pharmaceutical Corporation (Quipt Home Medical Columbus)
- Southern Pro Read, LLC
- Southern Prosthetic Care LLC
- Southern Urology Associates LLC
- Southern Vision Center Gulfport LLC (Southern Vision Center)
- Mae Ditta Spahr IX, CRNA
- Spark Counseling Center, LLC
- Michael Todd Spataro, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.