Provider Demographics
NPI:1497750426
Name:NEW ALBANY OUTPATIENT SURGERY, LLC
Entity Type:Organization
Organization Name:NEW ALBANY OUTPATIENT SURGERY, LLC
Other - Org Name:SURGICAL CENTER OF NEW ALBANY
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:B
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5900
Mailing Address - Street 1:2201 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4647
Mailing Address - Country:US
Mailing Address - Phone:812-949-1223
Mailing Address - Fax:812-945-4765
Practice Address - Street 1:2201 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4647
Practice Address - Country:US
Practice Address - Phone:812-949-1223
Practice Address - Fax:812-945-4765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN022237261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100274040Medicaid
INZM0060Medicare PIN