Provider Demographics
NPI:1831200815
Name:NOVAMED SURGERY CENTER OF SANTA ROSA, LLC
Entity type:Organization
Organization Name:NOVAMED SURGERY CENTER OF SANTA ROSA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:T
Authorized Official - Last Name:MACOMBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-780-3234
Mailing Address - Street 1:1720 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3602
Mailing Address - Country:US
Mailing Address - Phone:707-546-8100
Mailing Address - Fax:707-544-6438
Practice Address - Street 1:1720 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3602
Practice Address - Country:US
Practice Address - Phone:707-546-8100
Practice Address - Fax:707-544-6438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPPLIED FOR261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical