Surgical Associates of Mt Vernon, LTD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

SURGICAL ASSOCIATES OF MT VERNON, LTD

Practice address

2 Good Samaritan Way
Suite 235
Mount Vernon, IL 62864

Phone

(618) 899-3980

Fax

(618) 899-4793

NPI assigned

Feb 12, 2007

Organization subpart

No

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

Authorized official

Name

Annette Shores, M.D.

Title

Physician/Owner

Phone

(618) 899-3980

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390521600000",
    "number": "1790827491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 GOOD SAMARITAN WAY",
            "address_2": "SUITE 235",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "62864",
            "telephone_number": "618-899-3980",
            "fax_number": "618-899-4793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 GOOD SAMARITAN WAY",
            "address_2": "SUITE 235",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "62864",
            "telephone_number": "618-899-3980",
            "fax_number": "618-899-4793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL ASSOCIATES OF MT VERNON, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2014-01-24",
        "status": "A",
        "authorized_official_last_name": "SHORES",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "618-899-3980",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rose Marie Straeter, IBCLC
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• Surgery Physician in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2014; 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.