Provider Demographics
NPI:1073601332
Name:LISA RENFRO SURGERY CENTER LLC
Entity Type:Organization
Organization Name:LISA RENFRO SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-224-2260
Mailing Address - Street 1:2002 MEDICAL PKWY
Mailing Address - Street 2:SUITE 630
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-224-2260
Mailing Address - Fax:410-224-3090
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 630
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-224-2260
Practice Address - Fax:410-224-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1369261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD02QYOtherCAREFIRST MD
MDRA3OtherCAREFIRST DC
MD120615OtherJHHC
MDRA3OtherCAREFIRST DC