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General NPI Number Information
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NPI Number | 1285630160
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Entity Type | Organization
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Legal Business Name | NOVAMED EYE SURGERY CENTER OF NORTH COUNTY, LLC
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 03/06/2020
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Provider Practice Location Address
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Address Line | 12101 WOODCREST EXECUTIVE DR SUITE 101
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City | SAINT LOUIS
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State | MO
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Zip | 63141-5047
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Country | US
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Telephone | 866-631-7890
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Fax | 314-838-6532
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Provider Business Mailing Address
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Address Line | 12101 WOODCREST EXECUTIVE DR SUITE 101
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City | SAINT LOUIS
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State | MO
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Zip | 63141-5047
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Country | US
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Telephone | 314-838-0321
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Fax |
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Authorized Official
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Title or Position | OFFICER AND AUTHORIZED OFFICIAL
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Name | JENNIFER BOYD BALDOCK
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Credential |
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Telephone | 615-234-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 76-9
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License Number State | MO
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