Provider Demographics
NPI:1598756306
Name:YORK GREEN SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:YORK GREEN SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-583-9675
Mailing Address - Street 1:1300 YORK RD
Mailing Address - Street 2:BLDG C STE 200
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6016
Mailing Address - Country:US
Mailing Address - Phone:410-583-9675
Mailing Address - Fax:410-583-9680
Practice Address - Street 1:1300 YORK RD
Practice Address - Street 2:BLDG C STE 200
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6016
Practice Address - Country:US
Practice Address - Phone:410-583-9675
Practice Address - Fax:410-583-9680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1415261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD185ZMedicare ID - Type Unspecified