Provider Demographics
NPI:1790269462
Name:BARBOUR ORTHOPAEDICS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:BARBOUR ORTHOPAEDICS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:LUPOLI
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:615-478-8680
Mailing Address - Street 1:3240 NORTHEAST EXPRESSWAY
Mailing Address - Street 2:7B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341
Mailing Address - Country:US
Mailing Address - Phone:404-480-9330
Mailing Address - Fax:
Practice Address - Street 1:3240 NORTHEAST EXPRESSWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341
Practice Address - Country:US
Practice Address - Phone:404-480-9330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical