Provider Demographics
NPI:1114025608
Name:ELLICOTT CITY AMBULATORY SURGERY CENTER, LLLP
Entity Type:Organization
Organization Name:ELLICOTT CITY AMBULATORY SURGERY CENTER, LLLP
Other - Org Name:ELLICOTT CITY AMBULATORY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-461-1600
Mailing Address - Street 1:2850 NORTH RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043
Mailing Address - Country:US
Mailing Address - Phone:410-461-1600
Mailing Address - Fax:410-750-7615
Practice Address - Street 1:2850 NORTH RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:410-461-1600
Practice Address - Fax:410-750-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1003R261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410706300Medicaid
MDZZ43Medicare PIN
MD410706300Medicaid