Healthcare Provider Details

I. General information

NPI: 1457384554
Provider Name (Legal Business Name): THE ORTHOPEDIC SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E DE RENNE AVE
SAVANNAH GA
31405-6736
US

IV. Provider business mailing address

210 E DERENNE AVE
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 912-644-5343
  • Fax: 912-644-5398
Mailing address:
  • Phone: 912-644-5343
  • Fax: 912-644-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number125185
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00935558A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: ANGELA R MYERS
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 912-644-5343