1902804057 NPI number — NOVAMED SURGERY CENTER OF NASHUA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902804057 NPI number — NOVAMED SURGERY CENTER OF NASHUA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOVAMED SURGERY CENTER OF NASHUA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NASHUA EYE SURGERY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902804057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 COLISEUM AVE STE 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03063-3206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-882-9800
Provider Business Mailing Address Fax Number:
603-882-0556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 COLISEUM AVE STE 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03063-3206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-882-9800
Provider Business Practice Location Address Fax Number:
603-882-0556
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BALDOCK
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
BOYD
Authorized Official Title or Position:
OFFICER AND AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
615-234-5954

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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