COASTAL CAROLINA PHYSICIAN PRACTICES, LLC (NPI# 1326300781) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326300781 |
| Entity Type | Organization |
| Organization Name | COASTAL CAROLINA PHYSICIAN PRACTICES, LLC |
| Other Organization Name | SOUTHERN SURGICAL SPECIALISTS |
| Practice Address |
408 Jackson Ave E Hampton SC 29924-3602 |
| Practice Telephone | 8039434003 |
| Practice Fax Number | 8039434701 |
| Mailing Telephone | 8039434003 |
| Mailing Fax Number | 8039434701 |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2016-05-26 |
| Authorized Official Name | MR. WESLEY O. JAMES (REGIONAL CFO, TENET) |
| Authorized Official Telephone | 4042655009 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Southern Surgical Specialists | Doing Business As Name - Organization |
| Street Address |
408 JACKSON AVE E |
| City | HAMPTON |
| State | SC |
| Zip Code | 29924-3602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588613103 | Carlos E Montenegro | Surgery | 408 Jackson Ave E, Hampton, SC 29924 | 2006-05-09 |
| 1558507350 | Laurie B Harvey | Registered Nurse | 408 Jackson Ave E, Hampton, SC 29924 | 2008-12-29 |
| 1801991849 | Southern Surgery Specialists, LLC | Surgery | 408 Jackson Ave E, Hampton, SC 29924 | 2006-09-14 |
| 1891708699 | Vega Healthcare Inc. | Family Medicine | 408 Jackson Ave E, Hampton, SC 29924-3602 | 2006-08-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295247526 | Brittany Bernardino | Pharmacist | 1703 Elm Street W, Hampton, SC 29924 | 2017-10-26 |
| 1497278345 | Bryce Alan Stafford | Pharmacist | 1703 Elm Street West, Hampton, SC 29924 | 2017-07-24 |
| 1427486034 | Teresa L Gooding | Pharmacist | 1703 Elm Stree West, Hampton, SC 29924 | 2013-10-16 |
| 1811241672 | Sc Department of Juvenile Justice | Community/Behavioral Health | 230 1st Street East, Suite 7, Hampton, SC 29924 | 2012-11-01 |
| 1164771994 | Katie M Krise | Pharmacist | 705 Elm Street West, Hampton, SC 29924 | 2012-09-07 |
| 1801164587 | Susan R Britt | Specialist | 707 Elm St, Hampton, SC 29924 | 2011-12-08 |
| 1821384728 | John C Wagner | Pharmacist | 1703 Elm St W, Hampton, SC 29924 | 2011-06-20 |
| 1235424367 | Stanley Joseph Sledziona Jr. | Pharmacist | 1703 Elm St. W, Hampton, SC 29924 | 2011-06-16 |
| 1194010348 | Denise A. Pinckney | Pharmacist | 1703 Elm St West, Hampton, SC 29924 | 2011-06-16 |
| 1154430049 | Francis Asbury Mills | Dentist | 202 3rd St. East, Hampton, SC 29924 | 2006-08-30 |
| Find all providers in zip 29924 | ||||
| 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 |
|---|---|---|---|---|
| 1588613103 | Carlos E Montenegro | Surgery | 408 Jackson Ave E, Hampton, SC 29924 | 2006-05-09 |
| 1598176380 | Madison Griffin Lashley | Surgery | 77 Nealy Ave Bldg 257, Hampton, VA 23665 | 2014-05-14 |
| 1366700684 | Kenneth Sadler Meyers | Surgery | 3000 Coliseum Dr Ste 200, Hampton, VA 23666-5963 | 2012-04-24 |
| 1730310970 | Max Chae | Surgery | 77 Nealy Ave, Hampton, VA 23665-2040 | 2009-08-05 |
| 1285893495 | Robert Benjamin Swanson | Surgery | 77 Nealy Ave, 633d Medical Group, Hampton, VA 23665-2040 | 2008-06-03 |
| 1841474020 | Kelly Michelle Meehan | Surgery | 77 Nealy Ave, Langley Afb, Hampton, VA 23665-2040 | 2007-12-23 |
| 1083801294 | Sentara Medical Group | Surgery | 3000 Coliseum Dr, Suite 200, Hampton, VA 23666-5963 | 2007-10-02 |
| 1497841373 | Hampton Roads Surgical Associates PC | Surgery | 3000 Coliseum Drive, Suite 203, Hampton, VA 23666 | 2006-10-05 |
| 1801991849 | Southern Surgery Specialists, LLC | Surgery | 408 Jackson Ave E, Hampton, SC 29924 | 2006-09-14 |
| 1073520359 | Greg Y Kim | Surgery | 3000 Coliseum Dr, Ste 200, Hampton, VA 23666-5963 | 2006-08-01 |
| Find all providers in HAMPTON | ||||
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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.