1528151586 NPI number — ENDOSCOPIC SURGICAL CENTRE OF MARYLAND-NORTH LLC

Table of content: (NPI 1528151586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528151586 NPI number — ENDOSCOPIC SURGICAL CENTRE OF MARYLAND-NORTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDOSCOPIC SURGICAL CENTRE OF MARYLAND-NORTH 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:
6
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:
1528151586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15005 SHADY GROVE RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-6340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-762-1280
Provider Business Mailing Address Fax Number:
301-762-5678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15005 SHADY GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-6340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-762-1280
Provider Business Practice Location Address Fax Number:
301-762-5678
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLDEN
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CHIEF MANAGER OF LLC
Authorized Official Telephone Number:
615-665-1283

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1368 , 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: 522576 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 237001 . This is a "KAISER INSURANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6800326 . This is a "UNITEDHEALTHCARE PROVIDER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: PY6 . This is a "BC/BS OF DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 236707 . This is a "MAMSI PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61779101 . This is a "BC/BS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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