Provider Demographics
NPI:1043339625
Name:NOVAMED SURGERY CENTER OF CORAL SPRINGS LLC
Entity type:Organization
Organization Name:NOVAMED SURGERY CENTER OF CORAL SPRINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:T
Authorized Official - Last Name:MACOMBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-780-3234
Mailing Address - Street 1:5884 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:954-227-7760
Mailing Address - Fax:954-227-3036
Practice Address - Street 1:1725 N UNIVERSITY DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6089
Practice Address - Country:US
Practice Address - Phone:954-227-7760
Practice Address - Fax:954-227-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical