Organization
NOVAMED EYE SURGERY CENTER OF MARYVILLE, LLC
Active
Organization
NOVAMED EYE SURGERY CENTER OF MARYVILLE, LLC
Active
Parent organization
NOVAMED, INC.
Other names
Eyes of Illinois Surgery Center of Maryville
Organization subpart
Yes
Provider details
NPI number
Legal business name
NOVAMED, INC.
Authorized official
MR. SCOTT T. MACOMBER (EXECUTIVE VP AND CFO)
(312) 780-3234
Entity
Organization
Contact information
Practice address
12 MARYVILLE PROFESSIONAL PARK, MARYVILLE, IL 62062
(618) 288-7483
(618) 288-7196
Mailing address
12 PROFESSIONAL PARK DR, MARYVILLE, IL 62062-5672
(618) 288-7483
(618) 288-7196
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
7002132
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006032183
BCBS OF IL
IL
Enumeration date
06/01/2006
Last updated
04/20/2008
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