Provider Demographics
NPI:1093786501
Name:SURGERY CENTER OF EASTON LP
Entity Type:Organization
Organization Name:SURGERY CENTER OF EASTON LP
Other - Org Name:HEALTHSOUTH SURGERY CENTER OF EASTON, L.P.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP/CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-545-2572
Mailing Address - Street 1:510 IDLEWILD AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3824
Mailing Address - Country:US
Mailing Address - Phone:410-820-4470
Mailing Address - Fax:
Practice Address - Street 1:510 IDLEWILD AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3881
Practice Address - Country:US
Practice Address - Phone:410-820-4470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1236261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD062ZOtherMEDICARE PTAN
MD975500400Medicaid
MD975500400Medicaid