1730187337 NPI number — MT AIRY SURGERY CENTER, LLC

Table of content: (NPI 1730187337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730187337 NPI number — MT AIRY SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MT AIRY 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:
1730187337
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 TWIN ARCH RD
Provider Second Line Business Mailing Address:
SUITE 3C
Provider Business Mailing Address City Name:
MOUNT AIRY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21771-4138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-549-2100
Provider Business Mailing Address Fax Number:
410-549-2807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 TWIN ARCH RD
Provider Second Line Business Practice Location Address:
SUITE 3C
Provider Business Practice Location Address City Name:
MOUNT AIRY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21771-4138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-549-2100
Provider Business Practice Location Address Fax Number:
410-549-2807
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KELBY
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
SR VICE PRESIDENT-FINANCE
Authorized Official Telephone Number:
410-848-3000

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1089 , 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: 430400400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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