Healthcare Provider Details

I. General information

NPI: 1184627978
Provider Name (Legal Business Name): NOVAMED SURGERY CENTER OF ORLANDO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N ORANGE AVE SUITE 630
ORLANDO FL
32801-1026
US

IV. Provider business mailing address

801 N ORANGE AVE SUITE 630
ORLANDO FL
32801-1026
US

V. Phone/Fax

Practice location:
  • Phone: 866-631-7890
  • Fax: 407-650-0019
Mailing address:
  • Phone: 866-631-7890
  • Fax: 407-650-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1056
License Number StateFL

VIII. Authorized Official

Name: JENNIFER BOYD BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5900