SOUTHERN SPORTS SURGICAL, LLC. (NPI# 1558785683) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558785683 |
| Entity Type | Organization |
| Organization Name | SOUTHERN SPORTS SURGICAL, LLC. |
| Other Organization Name | INDIAN LAKE SURGERY CENTER |
| Practice Address |
127 Saundersville Rd. Suite A Hendersonville TN 37075-8902 |
| Practice Telephone | 6152658038 |
| Practice Fax Number | 6152658546 |
| Mailing Telephone | 6152658038 |
| Mailing Fax Number | 6152658546 |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2014-08-19 |
| Authorized Official Name | DR. THOMAS GAUTSCH (CEO) |
| Authorized Official Telephone | 6154182975 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Indian Lake Surgery Center | Doing Business As Name - Organization |
| Street Address |
127 SAUNDERSVILLE RD. SUITE A |
| City | HENDERSONVILLE |
| State | TN |
| Zip Code | 37075-8902 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528667425 | Results-ast Jv, LLC | Physical Therapist | 326 New Shackle Island Rd, Suite 300, Hendersonville, TN 37075 | 2020-10-21 |
| 1871126524 | Jessica Elise Williams | Nurse Practitioner | 100 Indian Lake Blvd, Hendersonville, TN 37075 | 2020-02-20 |
| 1003379108 | Infusion Express of Tennessee, PC | Clinic/Center | 1006 Glenbrook Way, Ste 130, Hendersonville, TN 37075 | 2019-04-08 |
| 1417414335 | Red Owl Industries, LLC | Chiropractor | 16 Executive Park Dr # 100, Hendersonville, TN 37075 | 2019-02-27 |
| 1992203368 | Cassie Berman | Occupational Therapist | 209 Shivel Drive, Hendersonville, TN 37075 | 2018-01-31 |
| 1407379373 | Hendersonville Smiles Dentistry, PC | Dentist | 1002 Glenbrook Way, Suite 200, Hendersonville, TN 37075 | 2017-07-21 |
| 1215483466 | Ryan Escue | Registered Nurse | 4221 Harding Pike, Nashville, TN 37075 | 2016-08-28 |
| 1003279589 | Grant Anderson | Physician Assistant | 211 Indian Lake Bloulevard, Hendersonville, TN 37075 | 2016-04-01 |
| 1073974192 | Jennifer Kramer | Nurse Practitioner | 103 Hazel Path Ct, Suite 7, Hendersonville, TN 37075 | 2016-03-16 |
| 1144680315 | Catherine Alexandria Wellendorf | Specialist/Technologist | 3126 Long Hollow Pike, Hendersonville, TN 37075 | 2016-03-02 |
| Find all providers in zip 37075 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740451327 | Huntley Surgical Consulting Inc | Clinic/Center | 513 N Justice St, Hendersonville, NC 28739-4328 | 2008-03-21 |
| 1093993727 | Carolina Mountain Gastroenterology Endoscopy Center | Clinic/Center | 1032 Fleming St, Hendersonville, NC 28791-3532 | 2008-02-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255939559 | Endoscopy Center of St Thomas Lp | Clinic/Center | 4230 Harding Pike Ste 309b, Nashville, TN 37205-2013 | 2020-10-09 |
| 1790344182 | Bristol Ambulatory Surgery Center, LLC | Clinic/Center | 350 Blountville Hwy Ste 108, Bristol, TN 37620-1676 | 2019-06-10 |
| 1528622321 | Premier-covenant Astc LLC | Clinic/Center | 6408 Papermill Dr Ste 220, Knoxville, TN 37919-4858 | 2019-04-26 |
| 1790348142 | The Plastic Surgery Center Brentwood | Clinic/Center | 620 Church Street East, Brentwood, TN 37027 | 2019-04-20 |
| 1326508045 | Eye Surgery Center of Lenoir City, LLC | Clinic/Center | 5491 Creekwood Park Blvd Ste B, Lenoir City, TN 37772-1204 | 2019-03-20 |
| 1629536826 | Meadowview Asc, LLC | Clinic/Center | 2033 Meadowview Ln Ste 210, Kingsport, TN 37660-7569 | 2019-03-06 |
| 1780157990 | Renaissance Surgery Center, LLC | Clinic/Center | 320 Bristol West Blvd Ste 1a, Bristol, TN 37620-8773 | 2019-01-10 |
| 1619487782 | Uch Vascular Access Asc LLC | Clinic/Center | 6490 Mt Moriah Rd Ext Ste 202, Memphis, TN 38115-3841 | 2017-10-03 |
| 1841712452 | Saint Thomas Surgery Center New Salem, LLC | Clinic/Center | 2755 New Salem Highway, Murfreesboro, TN 37128-3712 | 2017-07-14 |
| 1255860383 | Eye Surgery Center of Knoxville, LLC | Clinic/Center | 7739 Dannaher Drive, Powell, TN 37849 | 2017-06-12 |
| Find all providers with the same taxonomy | ||||
| City | HENDERSONVILLE |
| Zip Code | 37075 |
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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.