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Contact Information

PROVIDENT HEALTH SURGICAL ASSOCIATES, INC.
4700 WATERS AVE
SAVANNAH, GA31404-6220
 Phone: 912-350-2299
 Fax: 912-350-2298
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgical Oncology

2086X0206X 02 Physician/General Surgery
 

Gynecologic Oncology

207VX0201X 16 Physician/Obstetrics & Gynecology
 

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
 

Surgical Critical Care

2086S0102X 02 Physician/General Surgery
 

Thoracic Surgery (Cardiothoracic Vascular Surgery)

208G00000X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for PROVIDENT HEALTH SURGICAL ASSOCIATES, INC.

NPI # 1316195373
LBN Legal business name PROVIDENT HEALTH SURGICAL ASSOCIATES, INC.
Authorized official ROBIN MADDOX - (PROVIDER ENROLLMENT COORDINATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 09/03/2008
Last updated 05/03/2011 - About 15 years ago
Identifiers
GA Medicaid 824884292A
SC Medicaid GPA978
GA Other DO4195 RR MEDICARE
SC Other DO4198 RR MEDICARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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