Provider Demographics
NPI:1235416959
Name:SURGERY CENTER OF ANNAPOLIS, LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF ANNAPOLIS, LLC
Other - Org Name:SURGERY CENTER OF ANNAPOLIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-571-1280
Mailing Address - Street 1:130 ADMIRAL COCHRANE DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7368
Mailing Address - Country:US
Mailing Address - Phone:410-571-1280
Mailing Address - Fax:410-571-1288
Practice Address - Street 1:130 ADMIRAL COCHRANE DR
Practice Address - Street 2:SUITE 302
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7368
Practice Address - Country:US
Practice Address - Phone:410-571-1280
Practice Address - Fax:410-571-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QA1903X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD120187OtherCLIA