GENERAL SURGERY OF SOUTHAVEN LLC (NPI# 1164535415) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164535415 |
| Entity Type | Organization |
| Organization Name | GENERAL SURGERY OF SOUTHAVEN LLC |
| Practice Address |
401 Southcrest Cir Suite 210 Southaven MS 38671-6726 |
| Practice Telephone | 6625361944 |
| Practice Fax Number | 6625361947 |
| Mailing Telephone | 6625361944 |
| Mailing Fax Number | 6625361947 |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2016-03-24 |
| Authorized Official Name | DANIEL BENJAMIN FORE (OWNER) |
| Authorized Official Telephone | 6625361944 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 03873250 | 05 |
| Street Address |
401 SOUTHCREST CIR SUITE 210 |
| City | SOUTHAVEN |
| State | MS |
| Zip Code | 38671-6726 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578569935 | Sanjay Ratnakant | Internal Medicine | 401 Southcrest Cir, Ste 212, Southaven, MS 38671-6721 | 2005-06-21 |
| 1295240414 | Jenna Scruggs | Nurse Practitioner | 401 Southcrest Cir, Southaven, MS 38671-6726 | 2017-12-11 |
| 1083071237 | Wanda Brown | Nurse Practitioner | 401 Southcrest Cir, Suite 105, Southaven, MS 38671-6726 | 2016-01-19 |
| 1225403579 | Jodie Orr | Physical Therapist | 401 Southcrest Cir, Southaven, MS 38671-6726 | 2015-12-10 |
| 1487072864 | Shannon Rose Woods | Nurse Practitioner | 401 Southcrest Cir, Suite 212, Southaven, MS 38671-6726 | 2014-04-02 |
| 1669602603 | Rajeev Gupta | Internal Medicine | 401 Southcrest Cir, Suite 212, Southaven, MS 38671-6726 | 2009-07-24 |
| 1881850345 | Upasna Aron | Internal Medicine | 401 Southcrest Cir, Ste 201, Southaven, MS 38671-6726 | 2008-08-04 |
| 1093973836 | Urology Group PC | Urology | 401 Southcrest Cir, Suite 201, Southaven, MS 38671 | 2008-05-29 |
| 1679742944 | Adult Neurology Clinic Pllc | General Acute Care Hospital | 401 Southcrest Cir, Suite 210, Southaven, MS 38671-6726 | 2008-02-21 |
| 1255531885 | Foundation Internal Medicine, P.C. | Clinic/Center | 401 Southcrest Cir, Suite 207, Southaven, MS 38671-6726 | 2007-07-22 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285196196 | Emma Tinsley-bowles Long | Social Worker | 8786 Northcreek Blvd, Bldg 8 Apt 3, Southaven, MS 38671 | 2019-04-01 |
| 1851847586 | Tiffany Lashea Jones | Adult Companion | 8755 Millbranch Road, Southaven, MS 38671 | 2016-09-01 |
| 1538526140 | Desoto Pediatric Extended Care LLC | Skilled Nursing Facility | 750 Stateline Road East, Southhaven, MS 38671 | 2016-01-27 |
| 1073983052 | Tara Burt | Physical Therapist | 7900 Airways Blvd. Building A, Suite 2, Southaven, MS 38671 | 2015-10-02 |
| 1295160463 | Ideal Community Care,llc | In Home Supportive Care | 8869 Centre Str #3, Southaven, MS 38671 | 2013-09-06 |
| 1578995692 | Gregory Charles Eakins Jr. | Optometrist | 338 Goodman Rd West, Southaven, MS 38671 | 2013-07-31 |
| 1295173169 | Erica R. Martin | Social Worker | 975 Swinnea Rdg Ste 3, Southaven, MS 38671 | 2013-06-12 |
| 1386918431 | Freds Stores of Tennessee Inc | Pharmacy | 710 Church Road, Southaven, MS 38671 | 2012-03-06 |
| 1740565613 | Mary Jeanette Scruggs | Pharmacist | 1011 Goodman Rd, Southaven, MS 38671 | 2011-10-11 |
| 1184919268 | First Pharmacy Services 5 | Pharmacy | 5185a Getwell Rd, Southaven, MS 38671 | 2011-06-16 |
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| 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 |
|---|---|---|---|---|
| 1396909156 | Karan Kamal Bath | Surgery | 401 Southcrest Cir Ste 210, Southaven, MS 38671-6721 | 2008-07-10 |
| 1598877805 | Leander M Grimm | Surgery | 401 Southcrest Circle, Suite 204, Southaven, MS 38671 | 2006-08-31 |
| 1033170535 | Jason Wayne Hindman | Surgery | 401 Southcrest Cir Ste 201, Southaven, MS 38671-6721 | 2006-04-01 |
| 1215299656 | Alyssa Jameson Wier | Surgery | 401 Southcrest Cir Ste 201, Southaven, MS 38671-6721 | 2012-06-12 |
| 1568657666 | Michael E Foster Md PC | Surgery | 7580 Clarington Cv, Suite 4, Southaven, MS 38671-5657 | 2007-09-11 |
| 1861538951 | James Everett Fortune | Surgery | 7580 Clarington Cv, Southaven, MS 38671-5657 | 2007-01-29 |
| 1407969843 | Daniel B Fore | Surgery | 401 Southcrest Cir, Suite 210, Southaven, MS 38671-6726 | 2006-08-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528669041 | North Mississippi Medical Center Inc | Surgery | 499 S Gloster St Ste E, Tupelo, MS 38801-5539 | 2020-11-02 |
| 1285234104 | North Mississippi Medical Center, Inc. | Surgery | 499 Gloster Creek Vlg Ste S-3, Tupelo, MS 38801-4600 | 2020-10-29 |
| 1700344066 | Southwest Mississippi Regional Medical Center | Surgery | 1065 E Broad St., Monticello, MS 39654 | 2019-03-06 |
| 1740798503 | Cld Medical Enterprises Pllc | Surgery | 212 Draperton Ct Ste A, Ridgeland, MS 39157-3905 | 2018-01-15 |
| 1568912228 | Capel Surgical Clinic, LLC | Surgery | 406 E. Washington St., Greenwood, MS 38930 | 2016-10-06 |
| 1245610872 | Zachary Austin Masters | Surgery | 301 Fisher Street, Rm 5a127, Keesler Air Force Base, MS 39534 | 2015-06-09 |
| 1629477526 | Berry Enterprises LLC | Surgery | 756 Luckney Rd, Brandon, MS 39042-8703 | 2014-08-15 |
| 1649687906 | Almaz Kurbanov | Surgery | 1127 Earl Frye Blvd Ste B, Amory, MS 38821-5516 | 2014-07-18 |
| 1184036279 | Hope Burkett | Surgery | 147 Reynoir Street 201, Biloxi, MS 39530-9020 | 2014-05-23 |
| 1235568916 | Thomas Keener Billups Sr. | Surgery | 1929 Allyson Dr, Tupelo, MS 38804-1045 | 2013-11-04 |
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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.