Southern Physician Group Management LLC
Organization Active NPI Internal Medicine Physician · Nacogdoches, TX
NPI 1770162695 · NPPES record last updated Jul 26, 2022
Key facts
- NPI
- 1770162695
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- SOUTHERN PHYSICIAN GROUP MANAGEMENT LLC
- Practice address
- 1204 N Mound St
Nacogdoches, TX 75961-4027 - Phone
- (936) 564-4611
- NPI assigned
- Apr 7, 2021
- Organization subpart
- No
Authorized official
- Name
- Grant Douglass
- Title
- President
- Phone
- (361) 729-0646
Practitioners 47
-
Shawn Errol Armstrong, RN, MSN,ACNP-BC
-
Andrew Brod, MD
-
Eric Robert Estrada, M.D
-
Joseph Hollis Godwin, D.O.
-
Robert Jessie Atchison, M.D.
-
Charlotte Chase Appleton, M.D.
-
Bao Quoc Bui, M.D.
-
Robert Busuego, MD
-
Ruben De Los Santos, MD PA
-
Pamela Ann Ezzell, APRN, FNP-C
-
Scott Fagan, MD
-
Ravindra Reddy Gadam, M.D
-
Srinivasa Gurram, M.D
-
Mia Wynn Guzman, M.D.
-
Nader K Hijazi, MD
-
Maria Khan, DO
-
Stacy R McCown, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210506002594 | TX | Part B Supplier - Clinic/Group Practice | 6103235973 |
Receives reassigned benefits from 47 practitioners Practice locations: Breckenridge, TX; Carrizo Springs, TX; Eagle Pass, TX; Nacogdoches, TX |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | |||
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
1204 N Mound St
Nacogdoches, TX 75961-4027
Mailing address
PO Box 200039
Dallas, TX 75320-0039
Other providers in Nacogdoches, TX
- Vanessa Solis
- Le'Ann Little Solmonson
- Erin Nicole Sommerlatte
- Carissa A Sorenson
- Rodrigo William Sotillo
- Mark Ephrom Sowell
- Brooke Spann
- Arthur L Speck
- St. Alyssa Medical Center
- Andrew Staehling
All providers in Nacogdoches, TX · Internal Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.