MEDICARE: ROSWELL 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	060212	GA

General Provider Information

NPI Number	:	1720085277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSWELL SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	1285 HEMBREE RD
Second Line	:	STE 200C
City	:	ROSWELL
State	:	GA
Zip	:	30076-4995
Country	:	US
Telephone Number	:	770-772-5520
Fax Number	:

Provider Business Practice Location Address
First Line	:	1285 HEMBREE RD
Second Line	:	STE 200C
City	:	ROSWELL
State	:	GA
Zip	:	30076-4995
Country	:	US
Telephone Number	:	770-772-5520
Fax Number	:

Authorized Official
Title or Position	:	OFFICER / AUTHORIZED OFFICIAL
Name	:	COLLIN LEMAISTRE
Credential	:
Telephone Number	:	469-250-3640

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/11/2024

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