PROVIDENT HEALTH SURGICAL ASSOCIATES, INC. (NPI# 1104113307) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104113307 |
| Entity Type | Organization |
| Organization Name | PROVIDENT HEALTH SURGICAL ASSOCIATES, INC. |
| Other Organization Name | ACI SURGICAL ASSOCIATES |
| Practice Address |
4700 Waters Ave Suite 405 Savannah GA 31404-6220 |
| Practice Telephone | 9123502700 |
| Practice Fax Number | 9123502715 |
| Mailing Telephone | 9123502700 |
| Mailing Fax Number | 9123502715 |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2011-07-08 |
| Authorized Official Name | MRS. ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR) |
| Authorized Official Telephone | 9123509335 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| ACI Surgical Associates | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912149907 | Provident Health Surgical Associates, Inc. | Surgery | 4750 Waters Ave, Suite 103, Savannah, GA 31404-6200 | 2009-04-06 |
| 1083862882 | Provident Health Surgical Associates, Inc. | Obstetrics & Gynecology | 14 Okatie Center Blvd. South, Suite 101, Okatie, SC 29909 | 2008-09-04 |
| 1316195373 | Provident Health Surgical Associates, Inc. | Obstetrics & Gynecology | 4700 Waters Ave, Savannah, GA 31404-6220 | 2008-09-03 |
| Street Address |
4700 WATERS AVE SUITE 405 |
| City | SAVANNAH |
| State | GA |
| Zip Code | 31404-6220 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023012010 | Peter M Britt | Radiology | 4700 Waters Ave, Savannah, GA 31404-6220 | 2005-06-08 |
| 1255938288 | Mckenna Maria Valencia | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-10-02 |
| 1184239451 | Avery Thomas Helms | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-09-13 |
| 1619580800 | Matthew Shannon | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-26 |
| 1679184840 | Anna Tincher | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-12 |
| 1669083168 | Christie Vernon Klinginsmith | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-10 |
| 1396355004 | Noah Radjenovic | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-06 |
| 1558987115 | Alyssa Nadji | Registered Nurse | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-06-19 |
| 1952926065 | Mary Helen Ondriezek | Registered Nurse | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-06-15 |
| 1326661463 | Danielle Marie Carroll | Pharmacist | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-05-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043864580 | Carli A Boatright | Registered Nurse | 4750 Waters Ave Suite 206, Savannah, GA 31404 | 2019-08-01 |
| 1619530573 | Morgan Johnson | Student in an Organized Health Care Education/Training Program | Memorial Health University Medical Center, 4700 Waters Ave, Savannah, GA 31404 | 2019-04-17 |
| 1477050243 | Kevin Timperman | Student in an Organized Health Care Education/Training Program | 4700 Waters Avenus, Surgery Residency Program, Mhumc, Savannah, GA 31404 | 2018-04-09 |
| 1376048959 | Nina Jo Paletta | Student in an Organized Health Care Education/Training Program | Memorial University Medical Center, 4700 Waters Ave., Savannah, GA 31404 | 2018-03-27 |
| 1972036200 | Jose Adrian Lara Gonzalez | Student in an Organized Health Care Education/Training Program | 4700 Waters Ave, Memorial University Medical Center, Internal Medicine Residency Program, Savannah, GA 31404 | 2017-04-04 |
| 1407210396 | Lexie Hester Vaughn | Student in an Organized Health Care Education/Training Program | 1250 East 66th St, Savannah, GA 31404 | 2016-04-07 |
| 1336503291 | Miles Love | Student in an Organized Health Care Education/Training Program | 1250 East 66th Street, Savannah, GA 31404 | 2016-04-07 |
| 1134536881 | David Patch | Specialist/Technologist | Pediatric Residency Program, Memorial University, Medical Center 4700 Waters Avenue, Savannah, GA 31404 | 2014-07-15 |
| 1962846683 | Alan Danilo Zevallos | Internal Medicine | 4700 Waters Avenue, University Medical Center, Internal Medicine Residency Program, Memorial Health, Savannah, GA 31404 | 2013-04-24 |
| 1730446394 | Joshua Ryan Fann | Prosthetist | 3840 Waters Ave, Savannah, GA 31404 | 2012-04-19 |
| Find all providers in zip 31404 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386790129 | Derrick Brent Galapon | Surgery | 80 Enoch Blvd, Savannah, TN 38372-2231 | 2007-01-26 |
| 1861545790 | Javad Kenneth Tavassoli | Surgery | 4700 Waters Ave Rm 1300, Savannah, GA 31404-6220 | 2007-01-22 |
| 1922182534 | Richard Stephen Greene | Surgery | 910 Wayne Road, Savannah, TN 38372 | 2006-10-24 |
| 1801977434 | Savannah Surgical Center Pllc | Surgery | 255c Wayne Road, Savannah, TN 38372 | 2006-10-18 |
| 1619060415 | Ravindra K George | Surgery | 5354 Reynolds St Ste 202, Savannah, GA 31405-6009 | 2006-10-02 |
| 1346279965 | Charles Hendry Usher | Surgery | 5353 Reynolds St Ste 107, Savannah, GA 31405-6015 | 2006-07-03 |
| 1538197355 | Norman Lee Yates IIi | Surgery | 11909 Mcauley Drive, Suite 100 A2, Savannah, GA 31419 | 2006-06-29 |
| 1285662429 | Donald James Henley | Surgery | 1 Medical Arts Ctr, Savannah, GA 31405-4414 | 2006-06-28 |
| 1851335418 | Anne Teresa Saladyga | Surgery | 4700 Waters Ave Ste 405, Savannah, GA 31404-6220 | 2006-06-15 |
| 1306895073 | Howard A. Zaren | Surgery | 225 Candler Drive, Suite 301, Savannah, GA 31405 | 2006-05-09 |
| Find all providers in SAVANNAH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.