Surgery Clinic, LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

SURGERY CLINIC, LLC

Practice address

1622 Church Ave SE
Jacksonville, AL 36265-3200

Phone

(256) 547-6331

Fax

(256) 547-1711

NPI assigned

Jul 13, 2015

Organization subpart

Yes

Parent organization

SURGERY CLINIC, LLCAs reported in NPPES

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

Authorized official

Name

Mrs. Dianette Keener

Title

Billing Manager

Phone

(256) 547-6331

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Surgery Clinic, LLC - Jacksonville Doing business as

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Surgery Clinic, LLC

  • Surgery Physician
  • Gadsden, AL
  • NPI 1205893732

  O20110303000651

  Same enrollment
• Surgery Clinic, LLC

  • Surgery Physician
  • Centre, AL
  • NPI 1851681183

  O20110303000651

  Same enrollment
• The Surgery Clinic, LLC

  • Nuclear Medicine Technology Radiologic Technologist
  • Gadsden, AL
  • NPI 1508070293

  O20110303000651

  Same enrollment

Part of

John H Campbell MD

Locations

Practitioners 3

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

• Charles L Newman, M.D.

  • Surgery Physician
  • Gadsden, AL
  • NPI 1093772162
  NPD
• Lucian Newman III, M.D.

  • Surgery Physician
  • Gadsden, AL
  • NPI 1639136716
  NPD
• Paul Jorgen Nordness, M.D.

  • Surgery Physician
  • Gadsden, AL
  • NPI 1760456941
  NPD

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

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612915200000",
    "number": "1780068460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 S 5TH ST",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359015101",
            "telephone_number": "256-547-6331",
            "fax_number": "256-547-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1622 CHURCH AVE SE",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "362653200",
            "telephone_number": "256-547-6331",
            "fax_number": "256-547-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY CLINIC, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SURGERY CLINIC, LLC",
        "enumeration_date": "2015-07-13",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A",
        "authorized_official_last_name": "KEENER",
        "authorized_official_first_name": "DIANETTE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "256-547-6331",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "AL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528202650",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surgery Clinic, LLC - Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chase William Smith
• Rashada Camille Smith, LPC,NCC
• Nassar Ssempa
• Stoney Brook Emergency Physicians, PLLC
• Deandrea Joice Stowe
• T-Rad Inc
• Terry L Bonds,OD,PC
• The Health Care Authority of the City of Anniston
• The Health Care Authority of the City of Anniston
• The Health Care Authority of the City of Anniston

• Surgery Physician in Jacksonville, AL
• Providers in Jacksonville, AL by specialty
• Surgery Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2021; 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.