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General NPI Number Information
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NPI Number | 1609872597
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Entity Type | Organization
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Legal Business Name | COLISEUM SAME DAY SURGERY CENTER LP
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 340 HOSPITAL DR BLDG E
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City | MACON
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State | GA
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Zip | 31217-3838
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Country | US
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Telephone | 478-742-1403
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Fax | 478-742-7018
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Provider Business Mailing Address
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Address Line | PO BOX 6154
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City | MACON
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State | GA
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Zip | 31208-6154
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Country | US
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Telephone | 478-742-1403
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Fax | 478-742-7018
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. KAY BUXTON
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Credential |
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Telephone | 478-742-1403
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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 | 011-188
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License Number State | GA
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