PROVIDENT HEALTH SURGICAL ASSOCIATES, INC. (NPI# 1316195373) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316195373 |
| Entity Type | Organization |
| Organization Name | PROVIDENT HEALTH SURGICAL ASSOCIATES, INC. |
| Other Organization Name | ACI SURGICAL ASSOCIATES |
| Practice Address |
4700 Waters Ave Savannah GA 31404-6220 |
| Mailing Address |
Po Box 102019 Atlanta GA 30368-2019 |
| Practice Telephone | 9123502299 |
| Practice Fax Number | 9123502298 |
| Mailing Telephone | 9123502299 |
| Mailing Fax Number | 9123502298 |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2011-05-03 |
| 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 | 207VX0201X |
Obstetrics & Gynecology Specialization: Gynecologic Oncology |
Allopathic & Osteopathic Physicians | ||
| N | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians | ||
| N | 2086S0102X |
Surgery Specialization: Surgical Critical Care |
Allopathic & Osteopathic Physicians | ||
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Allopathic & Osteopathic Physicians | ||
| Y | 2086X0206X |
Surgery Specialization: Surgical Oncology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 824884292A | 05 | |
| GA | RR MEDICARE | DO4195 | 01 |
| SC | GPA978 | 05 | |
| SC | RR MEDICARE | DO4198 | 01 |
| Other Name | Type Code |
|---|---|
| ACI Surgical Associates | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104113307 | Provident Health Surgical Associates, Inc. | Nurse Practitioner | 4700 Waters Ave, Suite 405, Savannah, GA 31404-6220 | 2011-07-08 |
| 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 |
| Street Address |
4700 WATERS AVE |
| 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 | 2086X0206X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Surgical Oncology |
| A surgical oncologist is a well-qualified surgeon who has obtained additional training and experience in the multidisciplinary approach to the prevention, diagnosis, treatment, and rehabilitation of cancer patients, and devotes a major portion of his or her professional practice to these activities and cancer research. |
| Notes: Source: Society of Surgical Oncology, 2007 [1/1/2008: definition added, source added, 7/1/2009: definiition reformatted] Additional Resources: http://www.surgonc.org/ ; American Board of Medical Specialties, 2007, www.abms.org ; American Board of Surgery, 2007, http://www.absurgery.org/ Surgical oncology is a recognized fellowship subspecialty program of surgery. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023103165 | Cancer Care Pavilion Inc | Surgery | 225 Candler Dr., Ste 224, Savannah, GA 31405 | 2006-10-04 |
| 1508144981 | Provident Health Surgical Associates | Surgery | 4700 Waters Ave, Suite 403, Savannah, GA 31404-6220 | 2011-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750540233 | Shishir Kumar Maithel | Surgery | 101w Ponce De Leon Ave, Decatur, GA 30030-2528 | 2008-06-09 |
| 1851580575 | West Augusta Surgical Associates | Surgery | 2320 Wrightsboro Rd, Augusta, GA 30904-6233 | 2007-10-18 |
| 1942498050 | The Breast Care Team, PC | Surgery | 130 Riverstone Ter, Suite 101, Canton, GA 30114-1702 | 2007-10-15 |
| 1902003684 | Nicole Kounalakis | Surgery | 980 Johnson Fy Rd Ne Ste 940a, Atlanta, GA 30342-1609 | 2007-06-27 |
| 1093924409 | Taranjit Kaur Arora | Surgery | 1120 15th St Ste Bi1056, Augusta, GA 30912-0001 | 2007-05-22 |
| 1457401630 | Anita Johnson | Surgery | 120 N Medical Pkwy Bldg 100, Suite 201, Woodstock, GA 30189-7062 | 2007-01-11 |
| 1780746289 | Cletus Anthony Arciero | Surgery | 1364 Clifton Road, Ne, Emory University Hospital, Atlanta, GA 30322 | 2006-12-14 |
| 1083634067 | William Wood | Surgery | 1327 Clifton Rd Ne, Atlanta, GA 30322-1013 | 2006-07-20 |
| 1215932041 | Arnold Michael Conforti | Surgery | 800 1st St Ste 240, Macon, GA 31201-8300 | 2005-06-17 |
| 1497364749 | Bariatric and Minimally Invasive Surgical Institute | Surgery | 1105 Upper Hembree Rd Ste A, Roswell, GA 30076-0912 | 2020-07-23 |
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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.