Provider Demographics
NPI:1679570774
Name:NOVAMED SURGERY CENTER OF MADISON, LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:NOVAMED SURGERY CENTER OF MADISON, LIMITED PARTNERSHIP
Other - Org Name:
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 1:1200 JOHN Q HAMMONS DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1959
Mailing Address - Country:US
Mailing Address - Phone:608-827-5504
Mailing Address - Fax:
Practice Address - Street 1:1200 JOHN Q HAMMONS DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1959
Practice Address - Country:US
Practice Address - Phone:608-827-5504
Practice Address - Fax:608-827-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41913700Medicaid
P00190508OtherRR MEDICARE