Provider Demographics
NPI:1598847139
Name:ORTHOPAEDIC ASSOCIATES SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERZWURM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-396-3700
Mailing Address - Street 1:811 13TH ST
Mailing Address - Street 2:SUITE 21
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2700
Mailing Address - Country:US
Mailing Address - Phone:706-396-3700
Mailing Address - Fax:706-396-3759
Practice Address - Street 1:811 13TH ST
Practice Address - Street 2:SUITE 21
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2700
Practice Address - Country:US
Practice Address - Phone:706-396-3700
Practice Address - Fax:706-396-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121262261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA435205712AMedicaid
GA111225ASCAMedicare ID - Type UnspecifiedFACILITY PROVIDER NUMBER
GA435205712AMedicaid