Healthcare Provider Details

I. General information

NPI: 1609872597
Provider Name (Legal Business Name): COLISEUM SAME DAY SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 HOSPITAL DR BLDG E
MACON GA
31217-3838
US

IV. Provider business mailing address

PO BOX 6154
MACON GA
31208-6154
US

V. Phone/Fax

Practice location:
  • Phone: 478-742-1403
  • Fax: 478-742-7018
Mailing address:
  • Phone: 478-742-1403
  • Fax: 478-742-7018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number011-188
License Number StateGA

VIII. Authorized Official

Name: MS. KAY BUXTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 478-742-1403