Provider Demographics
NPI:1114920691
Name:NOVAMED SURGERY CENTER OF BEDFORD, LLC
Entity Type:Organization
Organization Name:NOVAMED SURGERY CENTER OF BEDFORD, LLC
Other - Org Name:N.H. EYE SURGICENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP OF THE MANAGER
Authorized Official - Prefix:MR
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 1:19 RIVERWAY PLACE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110
Mailing Address - Country:US
Mailing Address - Phone:603-627-9540
Mailing Address - Fax:603-668-7952
Practice Address - Street 1:105 RIVERWAY PLACE, BEDFORD COMMONS
Practice Address - Street 2:BUILDING #1
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-627-9540
Practice Address - Fax:603-668-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03001261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30C0001001Medicare PIN