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SOUTHERN GASTROENTEROLOGY ENDOSCOPY CENTER, P.C.
NPI 1265137517
Clinic/Center - Ambulatory Surgical in South Boston, VA

Active since April 04, 2023CLIA Certified · 2 labs
149 AUBREY'S LOOP, SOUTH BOSTON, VA 24592(434) 572-8196(434) 572-8341 Get Directions Write a Review

NPPES record last updated: August 6, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Aug 6, 2025, Apr 4, 2023 (2 updates tracked since 2023).

About Southern Gastroenterology Endoscopy Center, P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN GASTROENTEROLOGY ENDOSCOPY CENTER, P.C. (NPI 1265137517) is a healthcare organization registered as an ambulatory surgical in South Boston, Virginia and active in the NPI registry since April 2023. The organization holds 2 active CLIA laboratory certificates and lists Susan J Luedtke, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1265137517
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameSOUTHERN GASTROENTEROLOGY ENDOSCOPY CENTER, P.C.
Location Address149 AUBREY'S LOOPSouth Boston, VA 24592
Mailing Address149 Aubreys LoopSouth Boston, VA 24592-5056 · (434) 572-2810 · Fax (434) 255-0018
Phone(434) 572-8196
Fax(434) 572-8341
Organization SubpartNo
Authorized OfficialSusan J LuedtkePractice Manager · (434) 572-8196
Enumeration DateApril 4, 2023
Last NPPES UpdateAugust 6, 20252 updates tracked since enumeration
NPPES CertifiedAugust 6, 2025
✔ NPI 1265137517 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
149 AUBREY'S LOOP, South Boston, VA 24592
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Other Names 1

Other NameSouthern Gastroenterology Associates, Pc

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D2281645

Southern Gastroenterology Endoscopy Center PC · South Boston, VA
Active · expires May 9, 2027
CLIA Number49D2281645
Laboratory TypePhysician Office
Certificate Effective DateMay 10, 2025
Certificate Expiration DateMay 9, 2027
Laboratory DirectorSuresh G. Jayatilaka
Laboratory Phone(434) 572-8196
Laboratory LocationSouthern Gastroenterology Endoscopy Center PC149 Aubrey's Loop, South Boston, VA 24592
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 49D2110926

Southern Gastroenterology Associates, PC · South Boston, VA
Active · expires May 5, 2028
CLIA Number49D2110926
Laboratory TypePhysician Office
Certificate Effective DateMay 6, 2026
Certificate Expiration DateMay 5, 2028
Laboratory DirectorPablo C. Souza
Laboratory Phone(434) 572-8196
Laboratory LocationSouthern Gastroenterology Associates, PC1129 N Main St Suite G, South Boston, VA 24592
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions

What is SOUTHERN GASTROENTEROLOGY ENDOSCOPY CENTER, P.C.'s NPI number?

The NPI number assigned to this healthcare provider is 1265137517, enumerated as an "organization" on April 04, 2023.

Where is the provider located?

The provider is located at 149 AUBREY'S LOOP SOUTH BOSTON, VA 24592 and the phone number is (434) 572-8196.

What is the provider's specialty?

Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.