1376542076 NPI number — FREDERICK SURGICAL CENTER, LLC

Table of content: SUZANNE MARIE PROSSER CTRS (NPI 1356879209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376542076 NPI number — FREDERICK SURGICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREDERICK SURGICAL CENTER, LLC
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:
1376542076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14000 N. PORTLAND AVENUE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73134-4004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-608-1766
Provider Business Mailing Address Fax Number:
405-608-1866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 THOMAS JOHNSON DRIVE
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-694-3400
Provider Business Practice Location Address Fax Number:
301-694-3620
Provider Enumeration Date:
07/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NEWMAN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EVP AND COO
Authorized Official Telephone Number:
405-608-1709

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1039 , 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: ZZ70 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 414472400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 269918 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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