1215967351 NPI number — FRIENDSHIP AMBULATORY SURGERY CENTER

Table of content: (NPI 1215967351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215967351 NPI number — FRIENDSHIP AMBULATORY SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRIENDSHIP AMBULATORY SURGERY CENTER
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:
FRIENDSHIP AMBULATORY SURGERY CENTER
Provider Other Organization Name Type Code:
3
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:
1215967351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5550 FRIENDSHIP BLVD STE 270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEVY CHASE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20815-7297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-215-7347
Provider Business Mailing Address Fax Number:
301-715-7345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5550 FRIENDSHIP BLVD STE 270
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEVY CHASE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20815-7297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-215-7347
Provider Business Practice Location Address Fax Number:
301-715-7345
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRADDOCK
Authorized Official First Name:
MARY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
301-215-7347

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1131 , 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: 68-00013 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 325991900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 225660 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1490 . This is a "BC/BS OF DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 225660 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: ZZ13FR . This is a "BC/BS NASCO ACCTS." identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1143770001 . This is a "PALMETTO GOVT. TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1490 . This is a "CAREFIRST BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZ13FR . This is a "MARYLAND BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 225660 . This is a "MDIPA, ALL MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 490002518 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZ13FR . This is a "BC/BS NATIONAL ACCTS." identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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