Provider Demographics
NPI:1518090406
Name:HOTCHKISS SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:HOTCHKISS SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:STEPHAN
Authorized Official - Last Name:HOTCHKISS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-843-9581
Mailing Address - Street 1:12070 OLD LINE CTR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2513
Mailing Address - Country:US
Mailing Address - Phone:301-843-9581
Mailing Address - Fax:
Practice Address - Street 1:12070 OLD LINE CTR
Practice Address - Street 2:SUITE 110
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2513
Practice Address - Country:US
Practice Address - Phone:301-843-9581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1420261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21C0001420Medicare ID - Type Unspecified
MD190ZMedicare UPIN