Southern Medicine Primary & Urgent Care, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SOUTHERN MEDICINE PRIMARY & URGENT CARE, INC

Practice address

1405 Ohio Ave N
Live Oak, FL 32064-4868

Phone

(386) 209-0638

Fax

(386) 219-0470

NPI assigned

Jun 15, 2020

Organization subpart

No

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

Authorized official

Name

Michelle Morris, APRN

Title

President

Phone

(386) 209-0638

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Locations

Practitioners 1

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

• Michael L Ascough, FNP-C

  • Family Nurse Practitioner
  • Soddy Daisy, TN
  • NPI 1275277592
  NPD (past)

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

{
    "created_epoch": "1592179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652745600000",
    "number": "1841815826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6006",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320646006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 OHIO AVE N",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320644868",
            "telephone_number": "386-209-0638",
            "fax_number": "386-219-0470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MEDICINE PRIMARY & URGENT CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-15",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-209-0638",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12624827",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "michelle@southernmedicinepuc.com",
            "affiliation": "N",
            "address_1": "100 Court St SE",
            "city": "Live Oak",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320643203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "michelle@southernmedicinepuc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "100 Court St SE",
            "city": "Live Oak",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320643203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lacreasha Smith
• Jai' Leya N. Sobah, MS
• Constantinos Nichola Soldatos, D.M.D.
• Jenny Sotolongo, APRN, PMHNP-BC
• Southern Loving Care, Inc
• Speech Therapy Options, PLLC
• Deanna Darnell Spencer
• Robert Freeman Spindell, D.O.
• Kassidy Morgan Stallings, OTR/L
• Jason Allen Standridge

• Family Medicine Physician in Live Oak, FL
• Providers in Live Oak, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; 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.