Provider Demographics
NPI:1083606867
Name:NOVAMED SURGERY CENTER OF TYLER, LP
Entity Type:Organization
Organization Name:NOVAMED SURGERY CENTER OF TYLER, LP
Other - Org Name:CATARACT CENTER OF EAST TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP OF THE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MACOMBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-664-4100
Mailing Address - Street 1:802 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1900
Mailing Address - Country:US
Mailing Address - Phone:903-595-4333
Mailing Address - Fax:903-535-9845
Practice Address - Street 1:802 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-595-4333
Practice Address - Fax:903-535-9845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVAMED, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-18
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007870261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC146Medicare PIN