Marietta Outpatient Surgery, LTD

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

033163 Issued in GA

Legal business name

MARIETTA OUTPATIENT SURGERY, LTD

Practice address

780 Canton Rd NE
Suite 100
Marietta, GA 30060-7241

Phone

(770) 422-1579

Fax

(770) 422-1057

NPI assigned

Apr 18, 2006

Organization subpart

No

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

Authorized official

Name

William Gregory Swinney

Title

VP

Phone

(972) 789-2877

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

Marietta Outpatient Surgery LTDCCN 11C0001004

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

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

• Pinnacle Orthopaedics & Sports Medicine Specialists LLC

  • Orthopaedic Surgery Physician
  • Woodstock, GA
  • NPI 1316089121

  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.

• Juan Javier Servat, M.D.

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Suwanee, GA
  • NPI 1255530762
  NPD (past)

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518652800000",
    "number": "1669437109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 CANTON RD NE",
            "address_2": "SUITE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607241",
            "telephone_number": "770-422-1579",
            "fax_number": "770-422-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 CANTON RD NE",
            "address_2": "SUITE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607241",
            "telephone_number": "770-422-1579",
            "fax_number": "770-422-1057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA OUTPATIENT SURGERY, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2018-02-15",
        "status": "A",
        "authorized_official_last_name": "SWINNEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "GREGORY",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "972-789-2877"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "033163",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00354593A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marietta OB GYN Affiliates 2 LLC
• Marietta OB GYN Affiliates, P.a.
• Marietta OB GYN Affiliates, P.a.
• Marietta Opco, LLC
• Marietta Operating Company LLC
• Marietta Pastoral Counseling Center, Inc.
• Marietta Physical Rehab, L.L.C.
• Marietta Plastic Surgery
• Marietta Plastic Surgery
• Marietta Podiatry Group

• Ambulatory Surgical Clinic/Center in Marietta, GA
• Providers in Marietta, 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 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.