1861575219 NPI number — FOOT AND ANKLE SURGERY CENTER OF SILVER SPRING, LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861575219 NPI number — FOOT AND ANKLE SURGERY CENTER OF SILVER SPRING, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT AND ANKLE SURGERY CENTER OF SILVER SPRING, LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861575219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8505 FENTON ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20910-4497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-589-7663
Provider Business Mailing Address Fax Number:
301-589-3410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8505 FENTON ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20910-4497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-589-7663
Provider Business Practice Location Address Fax Number:
301-589-3410
Provider Enumeration Date:
10/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOX
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-589-7663

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1401 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 64642101 . This is a "CAREFIRST OF MD RENDERING" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3D . This is a "CAREFIRST MD PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: RW9 . This is a "GHMSI PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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