Provider Demographics
NPI:1649288325
Name:ROME ORTHOPAEDIC CENTER PC
Entity type:Organization
Organization Name:ROME ORTHOPAEDIC CENTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOWERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-292-0040
Mailing Address - Street 1:100 THREE RIVERS DR NE
Mailing Address - Street 2:STE A
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-4999
Mailing Address - Country:US
Mailing Address - Phone:706-292-0040
Mailing Address - Fax:706-378-0556
Practice Address - Street 1:100 THREE RIVERS DR NE
Practice Address - Street 2:STE A
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-4999
Practice Address - Country:US
Practice Address - Phone:706-292-0040
Practice Address - Fax:706-378-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207XS0106X, 207XS0114X, 207XX0005X, 207X00000X
GA059378207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300034419AMedicaid
GA4667320001Medicare NSC
GA300034419AMedicaid