Provider Demographics
NPI:1427307578
Name:HEMLOCK AMBULATORY SURGERY CENTER
Entity type:Organization
Organization Name:HEMLOCK AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:TAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-745-2385
Mailing Address - Street 1:101 PRESTON CT STE 104
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5771
Mailing Address - Country:US
Mailing Address - Phone:478-745-2385
Mailing Address - Fax:478-745-1225
Practice Address - Street 1:101 PRESTON CT STE 104
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5771
Practice Address - Country:US
Practice Address - Phone:478-745-2385
Practice Address - Fax:478-745-1225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011-473261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003132720AMedicaid
GA202G499688Medicare PIN