1093786501 NPI number — SURGERY CENTER OF EASTON LP

Table of content: (NPI 1093786501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093786501 NPI number — SURGERY CENTER OF EASTON LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGERY CENTER OF EASTON LP
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:
HEALTHSOUTH SURGERY CENTER OF EASTON, L.P.
Provider Other Organization Name Type Code:
4
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:
1093786501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 IDLEWILD AVE
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21601-3824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-820-4470
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 IDLEWILD AVE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21601-3881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-820-4470
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FIELDS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VP/CONTROLLER
Authorized Official Telephone Number:
205-545-2572

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1236 , 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: 062Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 975500400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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