Provider Demographics
NPI:1568513950
Name:MASSACHUSETTS AVENUE SURGERY CENTER
Entity Type:Organization
Organization Name:MASSACHUSETTS AVENUE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-263-0800
Mailing Address - Street 1:6400 GOLDSBORO RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-5826
Mailing Address - Country:US
Mailing Address - Phone:301-263-0800
Mailing Address - Fax:301-263-0820
Practice Address - Street 1:6400 GOLDSBORO RD
Practice Address - Street 2:SUITE 400
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-5826
Practice Address - Country:US
Practice Address - Phone:301-263-0800
Practice Address - Fax:301-263-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00064Medicare PIN