Basic Information
Provider Information
NPI: 1396171773
EntityType: 2
ReplacementNPI:  
OrganizationName: CATARACT SPECIALTY SURGICAL CENTER, LLC
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Mailing Information
Address1: 2218 RELIABLE PKWY
Address2:  
City: CHICAGO
State: IL
PostalCode: 606860022
CountryCode: US
TelephoneNumber: 8472965700
FaxNumber: 8472272750
Practice Location
Address1: 28747 WOODWARD AVE
Address2: LOWER LEVEL
City: BERKLEY
State: MI
PostalCode: 480720929
CountryCode: US
TelephoneNumber: 2485844602
FaxNumber: 2485844630
Other Information
ProviderEnumerationDate: 09/18/2013
LastUpdateDate: 02/27/2014
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AuthorizedOfficialLastName: MACOMBER
AuthorizedOfficialFirstName: SCOTT
AuthorizedOfficialMiddleName: T.
AuthorizedOfficialTitleorPosition: EVP AND CFO
AuthorizedOfficialTelephone: 3126644100
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: NOVAMED, INC.
AuthorizedOfficialNamePrefix: MR.
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X  Y193400000X SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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