Provider Demographics
NPI:1871598300
Name:NOVAMED SURGERY CENTER OF COLUMBUS, LLC
Entity type:Organization
Organization Name:NOVAMED SURGERY CENTER OF COLUMBUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP OF THE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MACOMBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-664-4100
Mailing Address - Street 1:7351 OLD MOON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-7291
Mailing Address - Country:US
Mailing Address - Phone:706-221-2721
Mailing Address - Fax:847-296-5990
Practice Address - Street 1:7351 OLD MOON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-1741
Practice Address - Country:US
Practice Address - Phone:706-221-2721
Practice Address - Fax:706-221-2754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVAMED, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-21
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106-257261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
111036ASCCMedicare PIN