Provider Demographics
NPI:1952454167
Name:SAVANNAH PELVIC RECONSTRUCTIVE SURGERY CENTER
Entity Type:Organization
Organization Name:SAVANNAH PELVIC RECONSTRUCTIVE SURGERY CENTER
Other - Org Name:UROGYN SAVANNAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:NICO
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-232-9700
Mailing Address - Street 1:PO BOX 23028
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31403-3028
Mailing Address - Country:US
Mailing Address - Phone:912-303-0891
Mailing Address - Fax:912-303-0893
Practice Address - Street 1:5356 REYNOLDS ST
Practice Address - Street 2:STE 301
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6016
Practice Address - Country:US
Practice Address - Phone:912-303-0891
Practice Address - Fax:912-303-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041008174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6584Medicare PIN