Novamed Eye Surgery Center of Maryville, LLC

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

7002132 Issued in IL

Legal business name

NOVAMED EYE SURGERY CENTER OF MARYVILLE, LLC

Doing business as

Eyes of Illinois Surgery Center of Maryville

Practice address

12 Maryville Professional Park
Maryville, IL 62062

Phone

(618) 288-7483

Fax

(618) 288-7196

NPI assigned

Jun 1, 2006

Organization subpart

Yes

Parent organization

NOVAMED, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Scott T. Macomber

Title

Executive VP and Cfo

Phone

(312) 780-3234

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Eyes of Illinois Surgery Center of Maryville Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Novamed Management Services LLC

  • Certified Registered Nurse Anesthetist
  • Atlanta, GA
  • NPI 1457344707

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1023055696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 PROFESSIONAL PARK DR",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625672",
            "telephone_number": "618-288-7483",
            "fax_number": "618-288-7196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 MARYVILLE PROFESSIONAL PARK",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "62062",
            "telephone_number": "618-288-7483",
            "fax_number": "618-288-7196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVAMED EYE SURGERY CENTER OF MARYVILLE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NOVAMED, INC.",
        "enumeration_date": "2006-06-01",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "MACOMBER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "EXECUTIVE VP AND CFO",
        "authorized_official_telephone_number": "312-780-3234",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "7002132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL",
            "identifier": "0006032183",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyes of Illinois Surgery Center of Maryville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• McKenzie Leigh Nikonovich, PMHNP-BC
• Nobbe Family Chiropractic, Inc.
• Kristin Elizabeth Nobbe-Bloemer, D.C.
• Hailey Nosalik, PHYSICIAN ASSISTANT
• Richard M Novak, DC, CCST
• Steven Paul Nuernberger, MD
• Nicole Nungesser, SLP
• Jessica Nussbaum, PA-C
• Jean McGurk O'Brien, M.A., LCPC, NCC
• Katherine Ober

• Certified Registered Nurse Anesthetist in Maryville, IL
• Providers in Maryville, IL by specialty
• Certified Registered Nurse Anesthetist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.