SOUTHERN STAR MEDICAL GROUP LLC (NPI# 1568794279) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568794279 |
| Entity Type | Organization |
| Organization Name | SOUTHERN STAR MEDICAL GROUP LLC |
| Practice Address |
67 Highpointe Dr Hattiesburg MS 39402-9536 |
| Mailing Address |
Po Box 4577 Greenville MS 38704-4577 |
| Practice Telephone | 6018745941 |
| Mailing Telephone | 6623328848 |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2010-02-04 |
| Authorized Official Name | DR. SIVARAMA K KOTIKALAPUDI (OWNER) |
| Authorized Official Telephone | 6017954969 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
18593 | MS | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | PENDING | 05 |
| Street Address |
67 HIGHPOINTE DR |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39402-9536 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518572965 | Resilient Therapy and Solutions, Pllc | Clinic/Center | 5266 Old Hwy 11 Ste 50, #308, Hattiesburg, MS 39402 | 2020-09-12 |
| 1932710225 | Jones County Medical Supplies, Inc | Durable Medical Equipment & Medical Supplies | 6424 Hwy 98 West, Suite 20, Hattiesburg, MS 39402 | 2020-08-11 |
| 1467086736 | Elizabeth A. Perry | Technician | 1220 Marrie St, Hattiesburg, MS 39402 | 2020-02-26 |
| 1225678063 | Connor Gregory Galloway | Physical Therapist | 3688 Veteran Memorial Drive, Hattiesburg, MS 39402 | 2020-01-09 |
| 1487291456 | Megan Marie Smith | Social Worker | 11 Woodstone Plaza, Hattiesburg, MS 39402 | 2019-12-09 |
| 1821656612 | Julie Covington Mcmahan | Dentist | 100 Madison Plaza, Hattiesburg, MS 39402 | 2019-06-05 |
| 1295392074 | Hattiesburg Clinic, Pa | Preventive Medicine | 6414 Highway 98, Suite 120, Hattiesburg, MS 39402 | 2019-05-28 |
| 1760945356 | Rachandeep Chahal | Student in an Organized Health Care Education/Training Program | 5001 Hardy Street Merit Health Wesley, Hattiesburg, MS 39402 | 2019-04-10 |
| 1386101137 | Courtney L Smith | Behavior Technician | 32 Millbanch Road, Suite 40, Hattiesburg, MS 39402 | 2019-02-28 |
| 1891269940 | Amanda Laine Mcarthur-macisaac | Registered Nurse | 5909 Highway 49 South, Suite 30, Hattiesburg, MS 39402 | 2019-01-11 |
| Find all providers in zip 39402 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982254389 | Lca of Ms, LLC | Clinic/Center | 6098 U S Highway 98 Ste 4, Hattiesburg, MS 39402-8878 | 2019-09-17 |
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|---|---|---|---|---|
| 1992303010 | Northwest Health and Wellness, Inc | Clinic/Center | 215 Northwest Drive, Senatobia, MS 38668 | 2020-10-12 |
| 1538786090 | Essential Health & Wellness Clinic P.a. | Clinic/Center | 5842 Goodman Rd Ste 1, Horn Lake, MS 38637-8106 | 2020-07-01 |
| 1144841826 | Love and Care Adult Daycare and Personal Care Services | Clinic/Center | 521 Brentwood Ave, Greenwood, MS 38930-6910 | 2020-05-04 |
| 1841849791 | Ayanna Hawkins | Clinic/Center | 1294 White Oak Rd, Tunica, MS 38676-9743 | 2019-09-04 |
| 1003463928 | Np Professional Services, LLC | Clinic/Center | 17 Church Cv, Beulah, MS 38726-9430 | 2019-08-26 |
| 1760035232 | Mcmedical Country Clinic LLC | Clinic/Center | 52 County Road 74, Mc Carley, MS 38943-6820 | 2019-07-23 |
| 1720550775 | Karen Jackson | Clinic/Center | 104 Taggart Dr, Steens, MS 39766-9563 | 2018-12-31 |
| 1831672435 | Healthcareonthego, LLC | Clinic/Center | 3901 King Rd, Meridian, MS 39305-2533 | 2018-09-10 |
| 1568949097 | Lifespan Wellness LLC | Clinic/Center | 101 Rouselle Pl Ste A, Ocean Springs, MS 39564-3074 | 2018-07-27 |
| 1013443811 | Jackson Diabetes Care and Consulting LLC | Clinic/Center | 2610 Traceland Dr Ste A, Tupelo, MS 38801-4237 | 2017-05-11 |
| Find all providers with the same taxonomy | ||||
| City | HATTIESBURG |
| Zip Code | 39402 |
Please comment or provide details below to improve the information on SOUTHERN STAR MEDICAL GROUP LLC.
| 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.