EMERGENCY MEDICINE SOUTH LLC (NPI# 1194785170) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194785170 |
| Entity Type | Organization |
| Organization Name | EMERGENCY MEDICINE SOUTH LLC |
| Practice Address |
2501 N Patterson St Valdosta GA 31602 |
| Mailing Address |
Po Box 402059 Atlanta GA 30384-2059 |
| Practice Telephone | 2293331000 |
| Mailing Telephone | 2293331000 |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2008-12-12 |
| Authorized Official Name | PAM KLEBOSITS (PRACTICE ADMINISTRATOR) |
| Authorized Official Telephone | 2292594660 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QE0002X |
Clinic/Center Specialization: Emergency Care |
Ambulatory Health Care Facilities | ||
| Y | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 258338100 | 05 | |
| FECA US DEPT OF LABOR | 158191000 | 01 | |
| GA | BLUE CROSS BLUE SHIELD | 5272824401 | 01 |
| FL | 256338100 | 05 | |
| GA | 300033708A | 05 |
| Street Address |
2501 N PATTERSON ST |
| City | VALDOSTA |
| State | GA |
| Zip Code | 31602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578566964 | John William Devine | Radiology | 2501 N Patterson St, Valdosta, GA 31602-1735 | 2005-05-31 |
| 1770100422 | Hospital Authority of Valdosta & Lowndes County, Ga | Clinical Medical Laboratory | 2501 N Patterson St, Valdosta, GA 31602-1735 | 2020-06-29 |
| 1700410602 | Danielle C Yund | Nurse Practitioner | 2501 N Patterson St, Valdosta, GA 31602-1735 | 2020-02-28 |
| 1417597170 | Sgmc Physician Network Inc | Emergency Medicine | 2501 N Patterson St, Valdosta, GA 31602-1735 | 2020-01-10 |
| 1497390116 | Stacey Newsome | Registered Nurse | 2501 N Patterson St, Valdosta, GA 31602-1735 | 2019-11-18 |
| 1508417296 | Coastal Plain Radiology LLC | Radiology | 2501 N Patterson St, Valdosta, GA 31602-1735 | 2019-09-24 |
| 1760030050 | Larissa Kathleen Frauenheim | Nurse Practitioner | 2501 N Patterson St, Valdosta, GA 31602-1785 | 2019-08-29 |
| 1336794734 | Jeffery Allan Baggett | Nurse Anesthetist, Certified Registered | 2501 N Patterson St, Valdosta, GA 31602-1785 | 2019-08-03 |
| 1689130312 | Kala Jo Bugg | Nurse Practitioner | 2501 N Patterson St, Valdosta, GA 31602-1785 | 2019-02-19 |
| 1588149819 | Philip Andrew Cooper | Nurse Practitioner | 2501 N Patterson St, Valdosta, GA 31602-1785 | 2018-10-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477198117 | Amber Michele Baugh | Behavior Technician | 2236 Bemiss Road, Valdosta, GA 31602 | 2019-11-15 |
| 1528611365 | Nishaben T. Patel | Nurse Practitioner | 3120 North Oak Street Extension, Suite B, Valdosta, GA 31602 | 2019-07-22 |
| 1427615871 | Blair Elizabeth Tomlinson | Nurse Practitioner | 2124 Lakeshore Drive, Valdosta, GA 31602 | 2019-05-21 |
| 1346704152 | Mildred Itaska Borowski | Counselor | 3790 North Highway 41, Suite A, Valdosta, GA 31602 | 2019-01-25 |
| 1962991703 | Southern Healthcare Alliance, LLC | Physical Medicine & Rehabilitation | 101-f W. Northside Drive, Valdosta, GA 31602 | 2018-05-08 |
| 1336636646 | Kaitlyn Thrift | Behavioral Analyst | 2225 Bemiss Road Suite D, Valdosta, GA 31602 | 2018-04-23 |
| 1407379845 | Lindsey Marie Richardson | Dentist | 103 W. Cranford Ave, Valdosta, GA 31602 | 2017-07-18 |
| 1962922427 | Taylor Nicole Fiveash | Nurse Practitioner | 101 W Northisde Dr, Bldg G, Valdosta, GA 31602 | 2017-06-26 |
| 1720520646 | Southern Sleepers Anesthesia LLC | Nurse Anesthetist, Certified Registered | 4120-b N. Valdosta Road, Valdosta, GA 31602 | 2016-11-09 |
| 1134670557 | Cataract and Laser Surgery Center of South Georgia, P.C. | Clinic/Center | 4120-b N. Valdosta Rd., Valdosta, GA 31602 | 2016-10-20 |
| Find all providers in zip 31602 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801216007 | Xenophon Mucciarone | Emergency Medicine | 300 N Patterson St, Valdosta, GA 31601-5519 | 2014-04-26 |
| 1205878386 | Alan Stout | Emergency Medicine | 612 N Patterson St, Valdosta, GA 31601-4610 | 2006-06-12 |
| 1679542781 | Douglas Moss | Emergency Medicine | 814 Northwood Park Dr, Valdosta, GA 31602-1398 | 2006-03-14 |
| 1205804622 | Simon Adames | Emergency Medicine | 3386 Greystone Way, Valdosta, GA 31605-1096 | 2006-03-10 |
| 1801887161 | James C Eutzler | Emergency Medicine | 520 Griffin Ave, Valdosta, GA 31601-6331 | 2005-11-04 |
| 1417597170 | Sgmc Physician Network Inc | Emergency Medicine | 2501 N Patterson St, Valdosta, GA 31602-1735 | 2020-01-10 |
| 1447701065 | Nes of Shelby Inc | Emergency Medicine | 2501 N Patterson St, Valdosta, GA 31602-1735 | 2016-10-19 |
| 1992169692 | Keegan Anne Michel | Emergency Medicine | 2501 N Patterson St, Valdosta, GA 31602-1735 | 2016-04-08 |
| 1700248788 | Eric Brent Edgerton | Emergency Medicine | 2501 N Patterson St, Valdosta, GA 31602-1785 | 2016-03-28 |
| 1306208558 | Davis Page Lester | Emergency Medicine | 2501 N Patterson St, Valdosta, GA 31602-1735 | 2016-03-27 |
| Find all providers in VALDOSTA | ||||
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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.