Healthcare Provider Details

I. General information

NPI: 1992706295
Provider Name (Legal Business Name): NOVAMED SURGERY CENTER OF ST. JOSEPH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 ASHLAND AVE
SAINT JOSEPH MO
64506-1504
US

IV. Provider business mailing address

1700 E HIGGINS RD SUITE 240
DES PLAINES IL
60018-5621
US

V. Phone/Fax

Practice location:
  • Phone: 816-279-0079
  • Fax: 816-364-1100
Mailing address:
  • Phone: 847-296-5700
  • Fax: 847-296-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number119-2
License Number StateMO

VIII. Authorized Official

Name: SCOTT MACOMBER
Title or Position: EVP OF THE MANAGER
Credential:
Phone: 312-664-4100