Provider Demographics
NPI:1437189354
Name:BELTSVILLE AMBULATORY SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:BELTSVILLE AMBULATORY SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEIBOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-937-5666
Mailing Address - Street 1:10720 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2138
Mailing Address - Country:US
Mailing Address - Phone:301-937-5666
Mailing Address - Fax:301-937-0453
Practice Address - Street 1:10720 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2138
Practice Address - Country:US
Practice Address - Phone:301-937-5666
Practice Address - Fax:301-937-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1216261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD312428Medicare PIN