Healthcare Provider Details

I. General information

NPI: 1114920691
Provider Name (Legal Business Name): NOVAMED SURGERY CENTER OF BEDFORD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 RIVERWAY PLACE, BEDFORD COMMONS BUILDING #1
BEDFORD NH
03110
US

IV. Provider business mailing address

19 RIVERWAY PLACE
BEDFORD NH
03110
US

V. Phone/Fax

Practice location:
  • Phone: 603-627-9540
  • Fax: 603-668-7952
Mailing address:
  • Phone: 603-627-9540
  • Fax: 603-668-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number03001
License Number StateNH

VIII. Authorized Official

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