Southern Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

015 Issued in MS

Legal business name

SOUTHERN SURGERY CENTER, LLC

Practice address

3688 Veterans Memorial Dr
Suite 100
Hattiesburg, MS 39401-8246

Phone

(601) 554-7525

Fax

(601) 554-7574

NPI assigned

Jul 19, 2005

Organization subpart

No

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

Authorized official

Name

Mr. David M. Burckel

Title

Ceo

Phone

(601) 554-7525

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Listed as

Southern Surgery CenterCCN 25C0001028

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261958400000",
    "number": "1912906157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3688 VETERANS MEMORIAL DR",
            "address_2": "SUITE 100",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394018246",
            "telephone_number": "601-554-7525",
            "fax_number": "601-554-7574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3688 VETERANS MEMORIAL DR",
            "address_2": "SUITE 100",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394018246",
            "telephone_number": "601-554-7525",
            "fax_number": "601-554-7574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-19",
        "last_updated": "2009-12-28",
        "status": "A",
        "authorized_official_last_name": "BURCKEL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-554-7525",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MS",
            "license": "015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00770390",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "000050871",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Neurologic & Spinal Institute
• Southern Neuroscience Center, PA
• Southern Physical Therapy, LLC
• Southern Smiles, PLLC
• Southern Star Medical Group LLC
• Southern Surgery Wound Care Clinic PLLC
• Southern Surgical Associates, P. a.
• Southern Surgical Associates, P. a.
• Southern Urology Surgery Center, LLC
• Southern Urology, P. a.

• Ambulatory Surgical Clinic/Center in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Ambulatory Surgical Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.