Georgia Lithotripsy and Laser Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GEORGIA LITHOTRIPSY AND LASER CENTER

Practice address

120 Trinity PL
Athens, GA 30607-2100

Phone

(706) 543-2718

Fax

(706) 353-3709

NPI assigned

Oct 4, 2006

Last updated

Nov 5, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David C AllenNPI 1669471496

Title

President

Phone

(706) 543-2718

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386739498. Details of each certification follow.

• CCN 11C0001026 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 11C0001026

Legal name

GEORGIA LITHOTRIPSY AND LASER

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Oct 16, 1990

Last certification

Oct 25, 2018

Ownership / control type

Proprietary

Facility address

120 Trinity Place
Athens, GA 30607

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Carter Allen, M.D.

  • Urology Physician
  • Athens, GA
  • NPI 1669471496
  Authorized official Same address or phone

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225843200000",
    "number": "1386739498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 TRINITY PL",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306072100",
            "telephone_number": "706-543-2718",
            "fax_number": "706-353-3709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 TRINITY PL",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306072100",
            "telephone_number": "706-543-2718",
            "fax_number": "706-353-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA LITHOTRIPSY AND LASER CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2008-11-05",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-543-2718"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QL0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Lithotripsy",
            "state": "GA",
            "license": "029-044",
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00451316A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "581596177001",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "590",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Athens, GA
• Providers in Athens, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.