Provider Demographics
NPI:1417929928
Name:AMERICAN SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:AMERICAN SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-997-0909
Mailing Address - Street 1:25480 POINT LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-3801
Mailing Address - Country:US
Mailing Address - Phone:301-997-0121
Mailing Address - Fax:301-997-0280
Practice Address - Street 1:25480 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3801
Practice Address - Country:US
Practice Address - Phone:301-997-0121
Practice Address - Fax:301-997-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403411201Medicaid
MD759MMedicare ID - Type Unspecified