Palmyra Surgical, LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

45711 Issued in GA

Legal business name

PALMYRA SURGICAL, LLC

Practice address

420 Charter Blvd
Suite 103
Macon, GA 31210-4854

Phone

(229) 432-8484

Fax

(229) 432-8487

NPI assigned

Dec 28, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Vito John Bagnato, MDNPI 1508853219

Title

Owner/President

Phone

(229) 432-8484

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Palmyra Surgical, LLC (Macon) Other name

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Palmyra Surgical, LLC

  • Surgery Physician
  • Macon, GA
  • NPI 1588868376

  O20070716000448

  Same enrollment

Locations

Practitioners 2

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

• Vito John Bagnato, M.D.

  • Surgery Physician
  • Macon, GA
  • NPI 1508853219
  NPD Authorized official
• Ronald Allen Freeman, M.D.

  • Plastic Surgery Physician
  • Macon, GA
  • NPI 1962479279
  NPD (past)

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

{
    "created_epoch": "1325030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325030400000",
    "number": "1851660443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 13TH AVE STE 108",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011333",
            "telephone_number": "229-432-8484",
            "fax_number": "229-432-8487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 CHARTER BLVD",
            "address_2": "SUITE 103",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312104854",
            "telephone_number": "229-432-8484",
            "fax_number": "229-432-8487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMYRA SURGICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-28",
        "last_updated": "2011-12-28",
        "status": "A",
        "authorized_official_last_name": "BAGNATO",
        "authorized_official_first_name": "VITO",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "229-432-8484",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "GA",
            "license": "45711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSISSIPPI LICENSE NUMBER",
            "identifier": "09936",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palmyra Surgical, LLC (Macon)",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Surgery Physician in Macon, GA
• Providers in Macon, GA by specialty
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2011; 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.