MEDICARE: NOVAMED SURGERY CENTER OF ORLANDO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	1056	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00253670	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184627978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVAMED SURGERY CENTER OF ORLANDO LLC

Provider Business Mailing Address
First Line	:	801 N ORANGE AVE
Second Line	:	SUITE 630
City	:	ORLANDO
State	:	FL
Zip	:	32801-1026
Country	:	US
Telephone Number	:	866-631-7890
Fax Number	:	407-650-0019

Provider Business Practice Location Address
First Line	:	801 N ORANGE AVE
Second Line	:	SUITE 630
City	:	ORLANDO
State	:	FL
Zip	:	32801-1026
Country	:	US
Telephone Number	:	866-631-7890
Fax Number	:	407-650-0019

Authorized Official
Title or Position	:	OFFICER AND AUTHORIZED OFFICIAL
Name	:	JENNIFER BOYD BALDOCK
Credential	:
Telephone Number	:	615-234-5900

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	02/21/2020

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Directions to “NOVAMED SURGERY CENTER OF ORLANDO LLC ” Practice Location

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