Provider Demographics
NPI:1275597056
Name:SURGERY CENTER OF ROME, LP
Entity Type:Organization
Organization Name:SURGERY CENTER OF ROME, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-879-4710
Mailing Address - Street 1:16 JOHN MADDOX DR NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1414
Mailing Address - Country:US
Mailing Address - Phone:706-802-3727
Mailing Address - Fax:706-802-3883
Practice Address - Street 1:16 JOHN MADDOX DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1414
Practice Address - Country:US
Practice Address - Phone:706-802-3727
Practice Address - Fax:706-802-3883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057282261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000372765AMedicaid
GA000372765AMedicaid