Provider Demographics
NPI:1184627978
Name:NOVAMED SURGERY CENTER OF ORLANDO LLC
Entity Type:Organization
Organization Name:NOVAMED SURGERY CENTER OF ORLANDO LLC
Other - Org Name:DOWNTOWN SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5900
Mailing Address - Street 1:801 N ORANGE AVE
Mailing Address - Street 2:SUITE 630
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1026
Mailing Address - Country:US
Mailing Address - Phone:866-631-7890
Mailing Address - Fax:407-650-0019
Practice Address - Street 1:801 N ORANGE AVE
Practice Address - Street 2:SUITE 630
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1026
Practice Address - Country:US
Practice Address - Phone:866-631-7890
Practice Address - Fax:407-650-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1056261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00253670OtherRR MEDICARE
FLF1288Medicare PIN