Lake Spivey Ambulatory Surgery Care, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

031127 Issued in GA

Legal business name

LAKE SPIVEY AMBULATORY SURGERY CARE, LLC

Doing business as

Spivey Station Surgery Center

Practice address

7813 Spivey Station Blvd
Suite 100
Jonesboro, GA 30236-2900

Phone

(770) 268-6000

NPI assigned

Feb 4, 2016

Organization subpart

No

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

Authorized official

Name

Christopher Doan

Title

Chief Compliance Counsel

Phone

(909) 235-4307

Specialties & licenses 1

Addresses

Other names 1

• Spivey Station Surgery Center Doing business as

Member of 1

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

• Health Emergency Assistance of Detroit

  • Family Medicine Physician
  • Detroit, MI
  • NPI 1285092767

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Prem Reddy, M.D.

  • Cardiovascular Disease Physician
  • Victorville, CA
  • NPI 1639120736
  NPD (past)

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

{
    "created_epoch": "1454544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454544000000",
    "number": "1487012480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 UPPER RIVERDALE RD SW",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742615",
            "telephone_number": "770-991-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7813 SPIVEY STATION BLVD",
            "address_2": "SUITE 100",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302362900",
            "telephone_number": "770-268-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SPIVEY AMBULATORY SURGERY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-04",
        "last_updated": "2016-02-04",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE COUNSEL",
        "authorized_official_telephone_number": "909-235-4307"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "031127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spivey Station Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jyothirmai Kondapaneni, MD
• Dale M Kristle, MD
• Jared Charles Kutzer, AA
• Margo Laboon, PT, DPT
• Wilermina Lacroix
• Matthieu Laliberte, MD
• Blair John Lamey, OD
• Julia Olivia Land, PSYD, CRC
• Laties, Inc.
• Taylor Lawrence

• Ambulatory Surgical Clinic/Center in Jonesboro, GA
• Providers in Jonesboro, 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 Feb 4, 2016; 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.