Provider Demographics
NPI:1093963696
Name:INTRALIGN MD LLC
Entity Type:Organization
Organization Name:INTRALIGN MD LLC
Other - Org Name:USA SURGICAL SERVICES MD LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR, CENTRAL BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:P
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-343-5500
Mailing Address - Street 1:PO BOX 21724
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1724
Mailing Address - Country:US
Mailing Address - Phone:813-865-1340
Mailing Address - Fax:813-865-1348
Practice Address - Street 1:7601 OSLER DRIVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:813-343-5500
Practice Address - Fax:866-698-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty