Provider Demographics
NPI:1437531860
Name:PREMIER SURGICAL PAVILION OF OXON HILL
Entity Type:Organization
Organization Name:PREMIER SURGICAL PAVILION OF OXON HILL
Other - Org Name:PREMIER SURGICAL PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-760-1546
Mailing Address - Street 1:PO BOX 1970
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10156-1970
Mailing Address - Country:US
Mailing Address - Phone:631-760-1546
Mailing Address - Fax:
Practice Address - Street 1:6178 OXON HILL RD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3109
Practice Address - Country:US
Practice Address - Phone:301-292-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical