MEDICARE: THE SURGERY CENTER, 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	106-216	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	158538900	OTHER	GA	WORKERSCOMP PROVIDER #
3	490004760	OTHER	GA	RAILROAD MCR PROVIDER #

General Provider Information

NPI Number	:	1609871847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	2548 WEEMS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-6248
Country	:	US
Telephone Number	:	706-323-8803
Fax Number	:	706-323-9101

Provider Business Practice Location Address
First Line	:	2548 WEEMS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-6248
Country	:	US
Telephone Number	:	706-323-8803
Fax Number	:	706-323-9101

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. LINDA SIMMONS
Credential	:	RN, BSN, MSHPA
Telephone Number	:	706-323-8803

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/17/2013

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Directions to “THE SURGERY CENTER, LLC ” Practice Location

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