Provider Demographics
NPI:1598775231
Name:SURGERY CENTER OF COLUMBIA COUNTY, LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF COLUMBIA COUNTY, LLC
Other - Org Name:SURGERY CENTER OF COLUMBIA COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-854-3020
Mailing Address - Street 1:4300 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3063
Mailing Address - Country:US
Mailing Address - Phone:706-854-3000
Mailing Address - Fax:706-854-3189
Practice Address - Street 1:4300 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3063
Practice Address - Country:US
Practice Address - Phone:706-854-3000
Practice Address - Fax:706-854-3189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11C0001289Medicare PIN