NPIMap

Organization Active NPI

Premier Ambulatory Surgical Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Marietta, GA
National Provider Identifier
1750629325
Registry record updated Jan 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
23819 Issued in GA
Legal business name
PREMIER AMBULATORY SURGICAL CENTER, LLC
Practice address
211 Chicopee Dr NE
Marietta, GA 30060-1269
Phone
(678) 872-8750
NPI assigned
Jan 16, 2013
Last updated
Jan 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2013

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

Authorized official

Name
Mr. Vernon E Spellman Sr.
Title
Administrator
Phone
(678) 872-8750

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 23819 GA Primary

Addresses

Primary practice location

211 Chicopee Dr NE
Marietta, GA 30060-1269

Mailing address

211 Chicopee Dr NE
Marietta, GA 30060-1269
Phone (678) 872-8750

Medicare participation

Medicare enrollment files
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 1750629325. Details of each certification follow.

Ambulatory surgical center certification: CCN 11C0001415

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PREMIER AMBULATORY SURGICAL CENTER, LLC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Dec 23, 2013
Last certification
Dec 23, 2013
Ownership / control type
Proprietary
Facility address
211 Chicopee Drive
Marietta, GA 30060

National Provider Directory

National Provider Directory

Locations

211 Chicopee Dr NE
Marietta, GA 30060
Phone (678) 872-8750

211 Chicopee Dr NE
Ste C
Marietta, GA 30060
Phone (678) 872-8750

NPI Registry JSON

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

{
    "created_epoch": "1358294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358294400000",
    "number": "1750629325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 CHICOPEE DR NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601269",
            "telephone_number": "678-872-8750",
            "fax_number": "678-872-8769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 CHICOPEE DR NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601269",
            "telephone_number": "678-872-8750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER AMBULATORY SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-16",
        "last_updated": "2013-01-16",
        "status": "A",
        "authorized_official_last_name": "SPELLMAN",
        "authorized_official_first_name": "VERNON",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "678-872-8750",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "23819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.