Provider Demographics
NPI:1053319053
Name:EYE SURGERY CENTER OF NEW ALBANY, LLC
Entity Type:Organization
Organization Name:EYE SURGERY CENTER OF NEW ALBANY, LLC
Other - Org Name:NOVAMED EYE SURGERY CENTER OF NEW ALBANY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRANN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:812-949-3442
Mailing Address - Street 1:520 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-3603
Mailing Address - Country:US
Mailing Address - Phone:812-949-3442
Mailing Address - Fax:
Practice Address - Street 1:520 W 1ST ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-3603
Practice Address - Country:US
Practice Address - Phone:812-949-3442
Practice Address - Fax:812-949-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-005401-1261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200503680AMedicaid
P00167103OtherRR MEDICARE