MEDICARE: NOVAMED SURGERY CENTER OF COLUMBUS, 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	106-257	GA

General Provider Information

NPI Number	:	1871598300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVAMED SURGERY CENTER OF COLUMBUS, LLC

Provider Business Mailing Address
First Line	:	7351 OLD MOON RD
Second Line	:	SUITE C
City	:	COLUMBUS
State	:	GA
Zip	:	31909-7291
Country	:	US
Telephone Number	:	706-221-2721
Fax Number	:	847-296-5990

Provider Business Practice Location Address
First Line	:	7351 OLD MOON RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-1741
Country	:	US
Telephone Number	:	706-221-2721
Fax Number	:	706-221-2754

Authorized Official
Title or Position	:	EVP OF THE MANAGER
Name	:	MR. SCOTT MACOMBER
Credential	:
Telephone Number	:	312-664-4100

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	10/22/2007

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