Provider Demographics
NPI:1427020007
Name:OUTPATIENT ORTHOPEDIC SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:OUTPATIENT ORTHOPEDIC SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FARR
Authorized Official - Suffix:
Authorized Official - Credentials:OPA-C, CASC
Authorized Official - Phone:912-681-6132
Mailing Address - Street 1:1601 FAIR RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-1698
Mailing Address - Country:US
Mailing Address - Phone:912-681-6732
Mailing Address - Fax:912-871-3098
Practice Address - Street 1:1601 FAIR RD
Practice Address - Street 2:SUITE 500
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1698
Practice Address - Country:US
Practice Address - Phone:912-681-6732
Practice Address - Fax:912-871-3098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016-285261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111243ASCAMedicare ID - Type UnspecifiedPROVIDER IDENTIFICATION #