Provider Demographics
NPI:1790717825
Name:SSCA SURGICAL ASSOCIATES OF COLUMBIA
Entity Type:Organization
Organization Name:SSCA SURGICAL ASSOCIATES OF COLUMBIA
Other - Org Name:SURGERY CENTER OF COLUMBIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-381-3700
Mailing Address - Street 1:PO BOX 1285
Mailing Address - Street 2:725 SOUTH JAMES CAMPBELL BLVD
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-381-3700
Mailing Address - Fax:931-381-9093
Practice Address - Street 1:725 SOUTH JAMES CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-381-3700
Practice Address - Fax:931-381-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000033208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1000992OtherBLUE CROSS
TN3287168Medicaid
TN3287168Medicare ID - Type Unspecified