Provider Demographics
NPI:1629078043
Name:NOVAMED EYE SURGERY CENTER OF OVERLAND PARK, LLC
Entity Type:Organization
Organization Name:NOVAMED EYE SURGERY CENTER OF OVERLAND PARK, LLC
Other - Org Name:OVERLAND PARK SURGERY CENTER
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:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5900
Mailing Address - Street 1:5520 COLLEGE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1630
Mailing Address - Country:US
Mailing Address - Phone:913-491-3040
Mailing Address - Fax:913-491-3640
Practice Address - Street 1:5520 COLLEGE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1630
Practice Address - Country:US
Practice Address - Phone:913-491-3040
Practice Address - Fax:913-491-3640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSS-046-005261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
490003071OtherRR MEDICARE
KS100279090AMedicaid
MO508157302Medicaid