NPIMap

Organization Active NPI

Southern Surgery Specialists, LLC

  • Surgery Physician
  • Hampton, SC
National Provider Identifier
1801991849
Registry record updated Nov 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
23479 Issued in SC
Legal business name
SOUTHERN SURGERY SPECIALISTS, LLC
Practice address
408 Jackson Ave E
Hampton, SC 29924
Phone
(803) 943-4003
Fax
(803) 943-4701
NPI assigned
Sep 14, 2006
Last updated
Nov 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2008

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

Authorized official

Name
Dr. Carlos E Montenegro, MDNPI 1588613103
Title
President
Phone
(803) 943-4003

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 23479 SC Primary

Addresses

Primary practice location

408 Jackson Ave E
Hampton, SC 29924

Mailing address

PO Box 1289
Varnville, SC 29944
Phone (803) 943-4003

Other identifiers 2

IdentifierTypeStateIssuer
1588613103OtherPROVIDER NPI
234794MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226016000000",
    "number": "1801991849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1289",
            "city": "VARNVILLE",
            "state": "SC",
            "postal_code": "29944",
            "telephone_number": "803-943-4003",
            "fax_number": "803-943-4701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 JACKSON AVE E",
            "city": "HAMPTON",
            "state": "SC",
            "postal_code": "29924",
            "telephone_number": "803-943-4003",
            "fax_number": "803-943-4701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN SURGERY SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2008-11-07",
        "status": "A",
        "authorized_official_last_name": "MONTENEGRO",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-943-4003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "23479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NPI",
            "identifier": "1588613103",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "234794",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hampton, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2008; 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.