Provider Demographics
NPI:1396171773
Name:CATARACT SPECIALTY SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:CATARACT SPECIALTY SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP AND 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:312-664-4100
Mailing Address - Street 1:2218 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0022
Mailing Address - Country:US
Mailing Address - Phone:847-296-5700
Mailing Address - Fax:847-227-2750
Practice Address - Street 1:28747 WOODWARD AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0929
Practice Address - Country:US
Practice Address - Phone:248-584-4602
Practice Address - Fax:248-584-4630
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVAMED, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-18
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty