MEDICARE: NOVAMED EYE SURGERY CENTER OF OVERLAND PARK, 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	S-046-005	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	490003071	OTHER		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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629078043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVAMED EYE SURGERY CENTER OF OVERLAND PARK, LLC

Provider Business Mailing Address
First Line	:	5520 COLLEGE BLVD
Second Line	:	SUITE 200
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1630
Country	:	US
Telephone Number	:	913-491-3040
Fax Number	:	913-491-3640

Provider Business Practice Location Address
First Line	:	5520 COLLEGE BLVD
Second Line	:	SUITE 200
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1630
Country	:	US
Telephone Number	:	913-491-3040
Fax Number	:	913-491-3640

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	10/13/2020

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