Provider Demographics
NPI:1518922541
Name:VISION SURGICAL CENTER AT SPRINGHILL PSC
Entity Type:Organization
Organization Name:VISION SURGICAL CENTER AT SPRINGHILL PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-258-4510
Mailing Address - Street 1:302 W 14TH ST
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3751
Mailing Address - Country:US
Mailing Address - Phone:812-284-1700
Mailing Address - Fax:812-284-1717
Practice Address - Street 1:302 W 14TH ST
Practice Address - Street 2:SUITE 100B
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3751
Practice Address - Country:US
Practice Address - Phone:812-284-1700
Practice Address - Fax:812-284-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200303160AMedicaid
INZM1090Medicare UPIN