Provider Demographics
NPI:1326549676
Name:CHATHAM ORTHOPAEDIC ASC, LLC
Entity Type:Organization
Organization Name:CHATHAM ORTHOPAEDIC ASC, LLC
Other - Org Name:CHATHAM ORTHOPAEDIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-355-6615
Mailing Address - Street 1:4425 PAULSEN ST BLDG B2ND
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3662
Mailing Address - Country:US
Mailing Address - Phone:912-777-3060
Mailing Address - Fax:
Practice Address - Street 1:4425 PAULSEN ST BLDG B2ND
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3662
Practice Address - Country:US
Practice Address - Phone:912-777-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical