NPIMap

Organization Active NPI

Provident Health Surgical Associates, Inc.

Doing business as ACI Surgical Associates

  • Surgical Oncology Physician
  • Savannah, GA
National Provider Identifier
1912149907
Registry record updated May 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Oncology PhysicianTaxonomy code 2086X0206X
Legal business name
PROVIDENT HEALTH SURGICAL ASSOCIATES, INC.
Doing business as
ACI Surgical Associates
Practice address
4750 Waters Ave
Suite 103
Savannah, GA 31404-6200
Phone
(912) 350-2299
Fax
(912) 350-2298
NPI assigned
Apr 6, 2009
Last updated
May 3, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2011

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

Authorized official

Name
Mrs. Robin J Maddox
Title
Provider Enrollment Coordinator
Phone
(912) 350-9335

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X
Surgical Oncology Physician 2086X0206X Primary

Addresses

Primary practice location

4750 Waters Ave
Suite 103
Savannah, GA 31404-6200

Mailing address

PO Box 102019
Atlanta, GA 30368-2019
Phone (912) 350-2299

Other identifiers 2

IdentifierTypeStateIssuer
824884292AMedicaidGA
DO4195OtherGARR MEDICARE

Other names 1

  • ACI Surgical Associates Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Aci Surgical Associates5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1238976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304380800000",
    "number": "1912149907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102019",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682019",
            "telephone_number": "912-350-2299",
            "fax_number": "912-350-2298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4750 WATERS AVE",
            "address_2": "SUITE 103",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314046200",
            "telephone_number": "912-350-2299",
            "fax_number": "912-350-2298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT HEALTH SURGICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-06",
        "last_updated": "2011-05-03",
        "status": "A",
        "authorized_official_last_name": "MADDOX",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT COORDINATOR",
        "authorized_official_telephone_number": "912-350-9335",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "824884292A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DO4195",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ACI Surgical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2011; 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.