VIDALIA SURGICAL ASSOCIATES, LLC (NPI# 1124216312) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124216312 |
| Entity Type | Organization |
| Organization Name | VIDALIA SURGICAL ASSOCIATES, LLC |
| Practice Address |
1811 Edwina Dr Vidalia GA 30474-8963 |
| Mailing Address |
Po Box 407 Vidalia GA 30475-0407 |
| Practice Telephone | 9125389977 |
| Mailing Telephone | 9125389977 |
| Mailing Fax Number | 9125380770 |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2020-07-10 |
| Authorized Official Name | TONY M OSTEEN (CFO) |
| Authorized Official Telephone | 9125385314 |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTHEAST REGIONAL CARE CORPORATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 192640864A | 05 |
| Street Address |
1811 EDWINA DR |
| City | VIDALIA |
| State | GA |
| Zip Code | 30474-8963 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609874197 | Robert Scanlon | Internal Medicine | 1811 Edwina Dr, Vidalia, GA 30474-8963 | 2005-07-08 |
| 1225531197 | Southeast Regional Primary Care Corporation | Internal Medicine | 1811 Edwina Dr, Vidalia, GA 30474-8963 | 2018-03-16 |
| 1568997914 | Debra Durden | Nurse Practitioner | 1811 Edwina Dr, Vidalia, GA 30474-8963 | 2017-04-24 |
| 1891109880 | Henry Leon Ferland IIi | Surgery | 1811 Edwina Dr, Vidalia, GA 30474-8963 | 2014-06-17 |
| 1346587755 | Joseph G Foust Md LLC | Family Medicine | 1811 Edwina Dr, Vidalia, GA 30474-8963 | 2013-01-07 |
| 1760702328 | Joy M Dunn | Surgery | 1811 Edwina Dr, Vidalia, GA 30474-8963 | 2010-06-07 |
| 1831325356 | Kendrix Jermaine Evans | Surgery | 1811 Edwina Dr, Vidalia, GA 30474-8963 | 2009-06-10 |
| 1194985093 | Vidalia Pulmonology Center, LLC | Internal Medicine | 1811 Edwina Dr, Vidalia, GA 30474-8963 | 2008-06-13 |
| 1649470410 | Southeast Ga Primary Prevent | Family Medicine | 1811 Edwina Dr, Vidalia, GA 30474-8963 | 2007-07-20 |
| 1396944633 | Southeastern Cardiology | Internal Medicine | 1811 Edwina Dr, Vidalia, GA 30474-8963 | 2007-07-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730655374 | Abby Virginia Adams | Speech-Language Pathologist | 101 Harris Insustrial Blvd, Vidalia, GA 30474 | 2018-10-22 |
| 1467930156 | Laurel Shiver Sapp | Nurse Practitioner | 1608 Meadows Ln, Vidalia, GA 30474 | 2018-08-03 |
| 1235658931 | Mary Frances Andrews | Nurse Practitioner | 1608 Meadows Lane Suite 1, Vidalia, GA 30474 | 2017-09-13 |
| 1154714574 | Georgia Eye Institute of The Southeast, LLC | Optometrist | 104 Andrews Street, Suite 112, Vidalia, GA 30474 | 2015-03-10 |
| 1790112571 | Tattnall Hospital Company, LLC | Surgery | 1702-a Meadows Lane, Vidalia, GA 30474 | 2013-10-10 |
| 1801235312 | Paul Anderson Youth Home, Inc. | Substance Abuse Rehabilitation Facility | 1603 Mcintosh Street, Vidalia, GA 30474 | 2013-06-18 |
| 1043591076 | Kimberly Thigpen Evans | Nurse Practitioner | 621 East First Street, Unit B, Vidalia, GA 30474 | 2011-09-03 |
| 1154614360 | Tattnall Hospital Company, LLC | Family Medicine | 1811 Edwina Drive, Vidalia, GA 30474 | 2011-05-20 |
| 1255586053 | Vidalia Medical Partners Inc. | Home Health | 801 Mcnatt Street, Vidalia, GA 30474 | 2008-11-20 |
| 1154596419 | Jill Nicole Lawrence | Speech-Language Pathologist | 1400 Ne Main St, Bethany Alf, Vidalia, GA 30474 | 2008-04-28 |
| Find all providers in zip 30474 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285814293 | Thomas M. Allen M.d., LLC | Specialist | 500 Maple Dr, Vidalia, GA 30474-8998 | 2007-11-07 |
| 1952507592 | Vidalia Women's Center, LLC | Specialist | 101 Harris Industrial Blvd., Suite C, Vidalia, GA 30474-8845 | 2007-06-21 |
| 1043378243 | Bhimani Internal Medicine | Specialist | 1809 Oneal Cir, Vidalia, GA 30474-5426 | 2006-12-04 |
| 1669555934 | Kurt P Hofmann Md LLC | Specialist | 303 Harris Industrial Blvd, Suite 3, Vidalia, GA 30474-8845 | 2006-10-23 |
| 1326079039 | Robert B Clark Jr Md LLC | Specialist | 1811 Manning Drive, Vidalia, GA 30474 | 2006-07-05 |
| 1104827369 | Paul Joseph Giles | Specialist | 1006 Mount Vernon Rd, Vidalia, GA 30474-3029 | 2005-08-09 |
| 1134127277 | Patrick J. Byrne | Specialist | One Meadows Parkway, Meadows Regional Medical Center, Vidalia, GA 30474 | 2005-07-12 |
| 1073015095 | Southeast Regional Primary Care Corporation | Specialist | 303 Harris Industrial Blvd, Vidalia, GA 30474-8853 | 2018-03-06 |
| 1205078979 | Vidalia Family Health Clinic LLC | Specialist | 1811 Manning Dr, Vidalia, GA 30474-8921 | 2009-03-27 |
| 1124284088 | Vidalia Urology Associates, LLC | Specialist | 1707 Meadows Ln Ste F, Vidalia, GA 30474-7201 | 2008-07-31 |
| Find all providers in VIDALIA | ||||
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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.