Eye Care Surgery Center of Southaven,LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

EYE CARE SURGERY CENTER OF SOUTHAVEN,LLC

Practice address

7600 Airways Blvd
Suite D
Southaven, MS 38671-5138

Phone

(662) 349-7477

Fax

(662) 349-7478

NPI assigned

Oct 23, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Subba R. Gollamudi, M.D.NPI 1154378735

Title

Medical Director

Phone

(901) 685-2200

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Listed as

Eye Care Surgery Center SouthavenCCN 25C0001057

Medicare certification status

ActiveFrom the Provider of Services file

Listed as

Eye Care Surgery Center of Southaven LLCCCN 25C0001108

Medicare certification status

ActiveFrom the Provider of Services file

Practitioners 2

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

• Subba R Gollamudi, M.D.

  • Ophthalmology Physician
  • Memphis, TN
  • NPI 1154378735
  NPD Authorized official
• Andrew M Krauss, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • Memphis, TN
  • NPI 1619918729
  NPD (past)

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658707200000",
    "number": "1780767673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 RIDGE LAKE BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209411",
            "telephone_number": "901-685-2200",
            "fax_number": "901-255-5631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 AIRWAYS BLVD",
            "address_2": "SUITE D",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386715138",
            "telephone_number": "662-349-7477",
            "fax_number": "662-349-7478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CARE SURGERY CENTER OF SOUTHAVEN,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "GOLLAMUDI",
        "authorized_official_first_name": "SUBBA",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "901-685-2200",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01022398",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeremy Erickson, MAMFTC
• Talunja Eskridge, LPC
• Mary Caroline Evangelisti
• Paul Evans, P.T.
• Evelyn HIV World Consult
• Priti Prakash Ezhuvathra, MD
• F.C. of Mississippi, Inc.
• Le'Brianna Fairley
• Golnaz Fakour Bayat Shirazi, MD
• Family Cancer Center, PLLC

• Ambulatory Surgical Clinic/Center in Southaven, MS
• Providers in Southaven, MS by specialty
• Ambulatory Surgical Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; 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.