Apex Medical Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 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

Last updated

Aug 7, 2019By 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

Mr. Davin G Mitchell, MD

Title

Owner

Phone

(762) 323-1030

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508210378. Details of each certification follow.

• CCN 11C0001463 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 11C0001463

Legal name

APEX MEDICAL SURGERY CENTER, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

May 18, 2017

Last certification

Nov 21, 2019

Ownership / control type

Proprietary

Facility address

1075 Lafayette Parkway Ste 110
Lagrange, GA 30241

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

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

• Total Diagnostic and Interventional Pain PC

  dba TDI Pain

  • Interventional Pain Medicine Physician
  • Lagrange, GA
  • NPI 1609143502

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1461024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565136000000",
    "number": "1508210378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 LAFAYETTE PKWY STE 100",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302413507",
            "telephone_number": "706-443-5273",
            "fax_number": "706-443-5275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 LAFAYETTE PKWY STE 100",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302413507",
            "telephone_number": "706-443-5273",
            "fax_number": "762-323-1014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APEX MEDICAL SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-19",
        "last_updated": "2019-08-07",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "DAVIN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "762-323-1030",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Lagrange, GA
• Providers in Lagrange, 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 Aug 7, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.