Provider Demographics
NPI:1508911728
Name:MINIMALLY INVASIVE SURGICAL AND NEUROSCIENCE LLC
Entity Type:Organization
Organization Name:MINIMALLY INVASIVE SURGICAL AND NEUROSCIENCE LLC
Other - Org Name:DELAWARE OUTPATIENT CENTER FOR SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:774 CHRISTIANA RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4236
Mailing Address - Country:US
Mailing Address - Phone:302-738-0300
Mailing Address - Fax:302-355-0159
Practice Address - Street 1:774 CHRISTIANA RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4236
Practice Address - Country:US
Practice Address - Phone:302-738-0300
Practice Address - Fax:302-355-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEFSSC013261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical