Provider Demographics
NPI:1194853796
Name:SURGERY CENTER OF BETHESDA, INC.
Entity Type:Organization
Organization Name:SURGERY CENTER OF BETHESDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-656-6055
Mailing Address - Street 1:8218 WISCONSIN AVE
Mailing Address - Street 2:SUITE P-14
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3107
Mailing Address - Country:US
Mailing Address - Phone:301-656-6055
Mailing Address - Fax:301-656-6058
Practice Address - Street 1:8218 WISCONSIN AVE
Practice Address - Street 2:SUITE P-14
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3107
Practice Address - Country:US
Practice Address - Phone:301-656-6055
Practice Address - Fax:301-656-6058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00023Medicare PIN