LAWRENCEVILLE SURGERY CENTER LLC NPI 1588619811

NPI Information

NPI: 1588619811
Provider Name: LAWRENCEVILLE SURGERY CENTER, LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 11D0985495

Address:
758 OLD NORCROSS RD
SUITE 125
LAWRENCEVILLE, GA
ZIP 30046
Phone: (678) 987-0820
Get Directions

LAWRENCEVILLE SURGERY CENTER, LLC is an ambulatory surgical clinic center in Lawrenceville, GA. LAWRENCEVILLE SURGERY CENTER, LLC NPI is 1588619811. The provider is registered as an organization entity type.

The provider's business location address is:

758 OLD NORCROSS RD
SUITE 125
LAWRENCEVILLE, GA
ZIP 30046-385
Phone: (678) 987-0820
Fax: (678) 987-0821

The provider's authorized official is Jenetha D Moran .
The authorized official title is Authorized Official and has the following contact phone number (972) 763-3893.

The CLIA number assigned to this NPI record is 11D0985495 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/24/2006 and was last updated on 7/30/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	067221	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	913003	OTHER	GEORGIA	BLUE CROSS BLUE SHIELD
2	000923414A	MEDICAID	GEORGIA
3	7813306	OTHER	GEORGIA	AETNA US HEALTHCARE
4	2633327	OTHER	GEORGIA	AETNA
5	68-00058	OTHER	GEORGIA	UNITED HEALTHCARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »