Organization
NOVAMED EYE SURGERY CENTER OF NORTH COUNTY, LLC
Active
Other names
Woodcrest Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BOYD BALDOCK (OFFICER AND AUTHORIZED OFFICIAL)
(615) 234-5900
Entity
Organization
Contact information
Practice address
12101 WOODCREST EXECUTIVE DR, SUITE 101, SAINT LOUIS, MO 63141-5047
(866) 631-7890
(314) 838-6532
Mailing address
12101 WOODCREST EXECUTIVE DR, SUITE 101, SAINT LOUIS, MO 63141-5047
(314) 838-0321
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
76-9
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
490003037
RR MEDICARE
—
05
—
505450205
—
MO
Enumeration date
06/24/2005
Last updated
03/06/2020
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