Healthcare Provider Details

I. General information

NPI: 1285755330
Provider Name (Legal Business Name): NOVAMED EYE SURGERY CENTER OF OVERLAND PARK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 COLLEGE BLVD
OVERLAND PARK KS
66211-1630
US

IV. Provider business mailing address

12239 COLLECTIONS CENTER DRIVE
CHICAGO IL
60693-0122
US

V. Phone/Fax

Practice location:
  • Phone: 913-491-3040
  • Fax:
Mailing address:
  • Phone: 913-906-6570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

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