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General NPI Number Information
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NPI Number | 1851397434
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Entity Type | Organization
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Legal Business Name | NOVAMED EYE SURGERY CENTER (PLAZA), LLC
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4321 WASHINGTON ST STE 6000
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City | KANSAS CITY
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State | MO
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Zip | 64111-5933
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Country | US
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Telephone | 816-753-6511
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Fax | 816-227-4099
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Provider Business Mailing Address
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Address Line | 1700 E HIGGINS RD STE 240
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City | DES PLAINES
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State | IL
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Zip | 60018-3888
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Country | US
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Telephone | 847-296-5700
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Fax | 847-296-5990
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Authorized Official
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Title or Position | EVP OF THE MANAGER
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Name | MR. SCOTT MACOMBER
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Credential |
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Telephone | 312-664-4100
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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 | 79-8
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License Number State | MO
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