SOUTHEAST GEORGIA HEALTH SYSTEM ENT SURGICAL CENTER
NPI 1336163096
Clinic/Center - Ambulatory Surgical in Brunswick, GA
NPI Status: Active since July 27, 2006
Contact Information
2916 GLYNN AVE
BRUNSWICK, GA
ZIP 31520
Phone: (912) 265-2573
Fax: (912) 262-0795
- Organization
- Clinic/Center
- Ambulatory Surgical
- CLIA Number: 11D1094211
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 01-13-2027
About SOUTHEAST GEORGIA HEALTH SYSTEM ENT SURGICAL CENTER
This page provides the complete NPI Profile along with additional information for Southeast Georgia Health System Ent Surgical Center, a provider established in Brunswick, Georgia operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1336163096 assigned on July 2006. The practitioner's primary taxonomy code is 261QA1903X with license number 063-316 (GA). The provider is registered as an organization and their NPI record was last updated 5 years ago. The provider's is doing business as Southeast Georgia Health System Ent Surgical Center. The authorized official of this NPI record is Mr. Michael David Scherneck Cpa (President & Ceo)
- NPI
- 1336163096
- Provider Legal Name
- COOPERATIVE HEALTHCARE SERVICES, INC.
- Other Organization Name
- SOUTHEAST GEORGIA HEALTH SYSTEM ENT SURGICAL CENTER
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 2916 GLYNN AVE BRUNSWICK, GA 31520
- Location Phone
- (912) 265-2573
- Location Fax
- (912) 262-0795
- Mailing Address
- 2415 PARKWOOD DR BRUNSWICK, GA 31520
- Mailing Phone
- (912) 466-7000
- Mailing Fax
- (912) 262-0795
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 07-27-2006
- Last Update Date
- 08-22-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Ambulatory Surgical
- Taxonomy Code
- 261QA1903X
- Type
- Ambulatory Health Care Facilities
- License No.
- 063-316
- License State
- GA
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 11D1094211
- Facility Type
- Physician Office
- Certificate Effective Date
- January 14, 2025
- Certificate Expiration Date
- January 13, 2027
- Laboratory Director
- JOHN M. BLUMER MD
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Southeast Georgia Health System Ent Surgical Center in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 3 | 3 | 6 | 1 | 6 | 3 | 0 | 9 | 6 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 3 | 6 | 6 | 2 | 6 | 6 | 0 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 3 + 6 + 6 + 2 + 6 + 6 + 0 + 1 + 8 + 24 = 64 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 64 = 6 | 6 | ||||||||
The NPI number 1336163096 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 3 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1265523120 | FRIEDRICH MEDICAL CENTER P.C. Organization | Specialist | 2916 GLYNN AVE BRUNSWICK, GA 31520 (912) 264-9650 |
| 1063501757 | ELIZABETH K WATSON NP Individual | Nurse Practitioner (Family) | 2916 GLYNN AVE BRUNSWICK, GA 31520 (912) 466-5850 |
| 1396271292 | JELISA CARROLL Individual | Family Medicine | 2916 GLYNN AVE BRUNSWICK, GA 31520 (912) 466-5850 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1336163096, enumerated in the NPI registry as an "organization" on July 27, 2006
The provider is located at 2916 Glynn Ave Brunswick, Ga 31520 and the phone number is (912) 265-2573
This medical organization specializes in Clinic/Center with taxonomy code 261QA1903X with a focus in Ambulatory Surgical
The provider's CLIA number is 11D1094211 for a "physician office" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing..
This NPI record was last updated on July 27, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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