Healthcare Provider Details

I. General information

NPI: 1902020522
Provider Name (Legal Business Name): ROME SURGICAL CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 REDMOND RD NW
ROME GA
30165-1537
US

IV. Provider business mailing address

PO BOX 2400
ROME GA
30164-2400
US

V. Phone/Fax

Practice location:
  • Phone: 706-802-1800
  • Fax: 706-802-0781
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number000618
License Number StateGA

VIII. Authorized Official

Name: DR. BRIAN MIDDLETON
Title or Position: D.P.M.
Credential:
Phone: 706-802-1800