MEDICARE: NOVAMED SURGERY CENTER OF SEBRING 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	805	FL

General Provider Information

NPI Number	:	1710057534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVAMED SURGERY CENTER OF SEBRING LLC

Provider Business Mailing Address
First Line	:	3601 S HIGHLANDS AVE
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-5418
Country	:	US
Telephone Number	:	863-382-7500
Fax Number	:	863-385-7332

Provider Business Practice Location Address
First Line	:	3601 S HIGHLANDS AVE
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-5418
Country	:	US
Telephone Number	:	863-382-7500
Fax Number	:	863-385-7332

Authorized Official
Title or Position	:	EXECUTIVE VP AND CFO
Name	:	MR. SCOTT T. MACOMBER
Credential	:
Telephone Number	:	312-780-3234

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	09/05/2007

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