Provider Demographics
NPI:1164297610
Name:THE SURGERY CLINICS LLC
Entity Type:Organization
Organization Name:THE SURGERY CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:JANNETTE
Authorized Official - Last Name:HUESO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-502-0577
Mailing Address - Street 1:PO BOX 10616
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20898-0616
Mailing Address - Country:US
Mailing Address - Phone:240-912-4576
Mailing Address - Fax:301-251-0070
Practice Address - Street 1:7501 FORBES BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6201
Practice Address - Country:US
Practice Address - Phone:240-912-4576
Practice Address - Fax:301-251-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD385000500Medicaid