Provider Demographics
NPI:1124093588
Name:UROLOGY SURGERY CENTER OF SAVANNAH, LLLP
Entity type:Organization
Organization Name:UROLOGY SURGERY CENTER OF SAVANNAH, LLLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-790-4000
Mailing Address - Street 1:PO BOX 13427
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-0427
Mailing Address - Country:US
Mailing Address - Phone:912-790-4068
Mailing Address - Fax:912-790-4407
Practice Address - Street 1:230 E DERENNE AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6736
Practice Address - Country:US
Practice Address - Phone:912-790-4068
Practice Address - Fax:912-790-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025276261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA916212415AMedicaid
SCASC062Medicaid
GA916212415AMedicaid