Provider Demographics
NPI:1962580266
Name:NOVAMED SURGERY CENTER OF WARRENSBURG LLC
Entity type:Organization
Organization Name:NOVAMED SURGERY CENTER OF WARRENSBURG LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:506 BURKARTH RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-3104
Mailing Address - Country:US
Mailing Address - Phone:660-747-1888
Mailing Address - Fax:660-747-1223
Practice Address - Street 1:506 BURKARTH RD
Practice Address - Street 2:SUITE B
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3104
Practice Address - Country:US
Practice Address - Phone:660-747-1888
Practice Address - Fax:660-747-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO194-0261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00387087OtherRR MEDICARE
MO508849205Medicaid