1861449571 NPI number — KIRURGS, LLC

Table of content: (NPI 1861449571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861449571 NPI number — KIRURGS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIRURGS, 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:
SURGEONS' SURGICAL CENTER
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:
1861449571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 714402
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45271-4402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-777-2543
Provider Business Mailing Address Fax Number:
301-777-2583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
940 SETON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-777-2543
Provider Business Practice Location Address Fax Number:
301-777-2583
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
301-777-2543

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1278 , 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: 056902000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com