Provider Demographics
NPI:1073644399
Name:PRIVATE SURGICAL SUITE, LLC
Entity Type:Organization
Organization Name:PRIVATE SURGICAL SUITE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:ZORC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-656-8008
Mailing Address - Street 1:PO BOX 71144
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20813-1144
Mailing Address - Country:US
Mailing Address - Phone:301-656-8008
Mailing Address - Fax:301-656-6701
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1455
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-8008
Practice Address - Fax:301-656-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1291261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00084595OtherRAILROAD MEDICARE
MDZX09PROtherMD BC NON PAR PROVIDER #
MDZX09PROtherMD BC NON PAR PROVIDER #