SOUTHERN UROLOGY ASSOCIATES LLC (NPI# 1962557157) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962557157 |
| Entity Type | Organization |
| Organization Name | SOUTHERN UROLOGY ASSOCIATES LLC |
| Practice Address |
12330 Ashley Dr Gulfport MS 39503-2737 |
| Practice Telephone | 2288311572 |
| Practice Fax Number | 2288311218 |
| Mailing Telephone | 2288311572 |
| Mailing Fax Number | 2288311218 |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | ROBERT J. LAGEESE (VICE PRESIDENT) |
| Authorized Official Telephone | 5049887044 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619919917 | Southern Urology Associates LLC | Urology | 15190 Community Rd, Suite 260, Gulfport, MS 39503-3485 | 2006-06-12 |
| Street Address |
12330 ASHLEY DR |
| City | GULFPORT |
| State | MS |
| Zip Code | 39503-2737 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447248661 | Curtis A Broussard | General Practice | 12330 Ashley Dr, Gulfport, MS 39503-2737 | 2005-10-11 |
| 1871523423 | Garden Park Physician Services Corp | Specialist | 12330 Ashley Dr, Gulfport, MS 39503-2737 | 2006-07-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013515451 | Gulf Coast Neurospa, LLC | Psychiatry & Neurology | 8845 Lorraine Road, Gulfport, MS 39503 | 2020-10-16 |
| 1447865985 | Nicholas Wyrosdick | Physical Therapist | 12261 Us 49 #1, Gulfport, MS 39503 | 2020-09-11 |
| 1750935169 | Ladner Roy Drugs, LLC. | Pharmacy | 12261 Us 49 Suite 16, Gulfport, MS 39503 | 2019-07-25 |
| 1528559440 | Alexander Therapy Services, LLC | Clinic/Center | 15465 Oak Ln Ste 100c, Gulfport, MS 39503 | 2018-05-25 |
| 1750879003 | Heather Lynn Theisen | Nurse Practitioner | 15190 Community Rd Ste 330, Gulfport, MS 39503 | 2018-04-23 |
| 1083101216 | Gulf Coast Mental Health Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15094 County Barn Road, Gulfport, MS 39503 | 2018-04-13 |
| 1306343173 | Dr. Raymond Monsour Scurfield, LLC | Community/Behavioral Health | 15465 Oak Lane Ste 100-g, Gulfport, MS 39503 | 2018-04-09 |
| 1952817157 | Mary Beth Welch | Behavioral Analyst | 9230 Old Lorraine Rd, Gulfport, MS 39503 | 2017-12-26 |
| 1831603257 | Beach View Family Dental, Pllc | Dentist | 9072 Lorraine Road, Gulfport, MS 39503 | 2017-11-21 |
| 1437677721 | Mary Stephens Ruffin | Social Worker | 11262 Creek Dr, Gulfport, MS 39503 | 2017-09-07 |
| Find all providers in zip 39503 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023678000 | The Urology Clinic, LLC | Urology | 14231 Seaway Rd Ste 6000, Gulfport, MS 39503-4628 | 2019-06-20 |
| 1407969207 | Memorial Hospital At Gulfport | Urology | 1340 Broad Ave Ste 210, Gulfport, MS 39501-2465 | 2006-08-16 |
| 1093031494 | Memorial Hospital At Gulfport | Urology | 15190 Community Rd, Suite 240, Gulfport, MS 39503-3485 | 2010-04-12 |
| 1871737064 | Jacob N Jorns | Urology | 1340 Broad Ave Ste 210, Gulfport, MS 39501-2465 | 2009-05-01 |
| 1669619912 | Memorial Hospital of Gulfport | Urology | 1340 Broad Ave, Ste 210, Gulfport, MS 39501-2404 | 2009-01-08 |
| 1962690255 | Memorial Hospital At Gulfport | Urology | 1340 Broad Ave, Suite 210, Gulfport, MS 39501-2404 | 2007-10-11 |
| 1194825216 | Paige C White | Urology | 1340 Broad Ave, Suite 210, Gulfport, MS 39501-2404 | 2006-09-25 |
| 1548285968 | David Champ Weeks | Urology | 1340 Broad Ave, Suite 210, Gulfport, MS 39501-2404 | 2006-07-13 |
| 1760417612 | Arthur M Matthews Jr. | Urology | 15190 Community Rd, Suite 370, Gulfport, MS 39503-3485 | 2006-07-11 |
| 1619919917 | Southern Urology Associates LLC | Urology | 15190 Community Rd, Suite 260, Gulfport, MS 39503-3485 | 2006-06-12 |
| Find all providers in GULFPORT | ||||
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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.