EYE CARE SURGERY CENTER OF SOUTHAVEN,LLC – NPI #1780767673
Clinic/Center

EYE CARE SURGERY CENTER OF SOUTHAVEN,LLC is an AHC clinic located in SOUTHAVEN, MS. NPPES has assigned the NPI number 1780767673 to EYE CARE SURGERY CENTER OF SOUTHAVEN,LLC on October 23, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QA1903X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Ambulatory Surgical

The NPI profile was previously updated about 4 years ago on Jul 25, 2022. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for EYE CARE SURGERY CENTER OF SOUTHAVEN,LLC below.

NPI Profile for
EYE CARE SURGERY CENTER OF SOUTHAVEN,LLC

NPI Number
1780767673
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
EYE CARE SURGERY CENTER OF SOUTHAVEN,LLC
Primary location
7600 AIRWAYS BLVD
SUITE D
SOUTHAVEN, MS 38671-5138
Phone: (662) 349-7477 Fax: (662) 349-7478
Mailing address
825 RIDGE LAKE BLVD
MEMPHIS, TN 38120-9411
Phone: (901) 685-2200 Fax: (901) 255-5631
Organization Subpart
No
Authorized Official
SUBBA GOLLAMUDI
MEDICAL DIRECTOR
Phone: (901) 685-2200
Updated
Certification Date
Jul 25, 2022

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for EYE CARE SURGERY CENTER OF SOUTHAVEN,LLC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDMS01022398
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QA1903X
- Clinic/Center / Ambulatory Surgical (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.