1447258603 NPI number — SNOWDEN RIVER SURGERY CENTER LLC

Table of content: (NPI 1447258603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447258603 NPI number — SNOWDEN RIVER SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SNOWDEN RIVER SURGERY 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:
1447258603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6011 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
SUITE 190
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21043-6074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-461-0960
Provider Business Mailing Address Fax Number:
410-461-0967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6011 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
SUITE 190
Provider Business Practice Location Address City Name:
ELLICOTT CITY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21043-6074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-461-0960
Provider Business Practice Location Address Fax Number:
410-461-0967
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GROCHMAL
Authorized Official First Name:
JAY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
410-461-0960

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1416 , 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: 253605 . This is a "KAISER PERMANENTE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 408126900 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2139172 . This is a "UNITED HEALTH CARE MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: RW3 . This is a "CARE FIRST BCBS XIC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3968840 . This is a "AETNA MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2139172 . This is a "ONE NET" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2139172 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3968840 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: RW3 . This is a "CARE FIRST BCBS FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 116594 . This is a "JOHN HOPKINS HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 64628701 . This is a "CARE FIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7374667 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P00220115 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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