Organization
BROOKSTONE SURGICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD C BLOOM MD (MEDICAL DIRECTOR)
(706) 653-7008
Entity
Organization
Contact information
Practice address
1000 CENTRE BROOK COURT, COLUMBUS, GA 31904
(706) 576-4474
Mailing address
1000 CENTRE BROOK COURT, COLUMBUS, GA 31904
(706) 576-4474
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
106-459
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00476693H
—
GA
Enumeration date
01/27/2011
Last updated
07/09/2014
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