Provider Demographics
NPI:1790715506
Name:SOUTHERN SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:SOUTHERN SURGICAL ASSOCIATES LLC
Other - Org Name:COMMONWEALTH SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VASKEN
Authorized Official - Middle Name:KEVORK
Authorized Official - Last Name:TENEKJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-397-2383
Mailing Address - Street 1:3640 HIGH ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3213
Mailing Address - Country:US
Mailing Address - Phone:757-397-2383
Mailing Address - Fax:757-397-5201
Practice Address - Street 1:3640 HIGH ST
Practice Address - Street 2:SUITE 2F
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3213
Practice Address - Country:US
Practice Address - Phone:757-397-2383
Practice Address - Fax:757-397-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05853OtherMEDICARE GROUP NUMBER