Apex Medical Surgery Center, LLC
Organization Active NPI Ambulatory Surgical Clinic/Center · Lagrange, GA
NPI 1508210378 · NPPES record last updated Aug 7, 2019
Key facts
- NPI
- 1508210378
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- Legal business name
- APEX MEDICAL SURGERY CENTER, LLC
- Practice address
- 1075 Lafayette Pkwy Ste 100
Lagrange, GA 30241-3507 - Phone
- (706) 443-5273
- Fax
- (762) 323-1014
- NPI assigned
- Apr 19, 2016
- Organization subpart
- No
Authorized official
- Name
- Mr. Davin G Mitchell, MD
- Title
- Owner
- Phone
- (762) 323-1030
Member of 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2110521 | Apex Medical Surgery Center, LLC | Certificate of waiver | Mar 15, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170623001891 | GA | Part B Supplier - Ambulatory Surgical Center | 3375811896 | Practice locations: Lagrange, GA |
National Provider Directory
Locations
1075 Lafayette Pkwy
Ste 100
Lagrange, GA 30241
Phone (706) 443-5273
1075 Lafayette Pkwy
Ste 110
Lagrange, GA 30241
Phone (706) 501-9789
1075 Lafayette Pkwy
Lagrange, GA 30241
Phone (706) 350-1338
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Yes |
Addresses
Primary practice location
1075 Lafayette Pkwy Ste 100
Lagrange, GA 30241-3507
Mailing address
1075 Lafayette Pkwy Ste 100
Lagrange, GA 30241-3507
Phone (706) 443-5273
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003210036A | Medicaid | GA |
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All providers in Lagrange, GA · Ambulatory Surgical Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.