Provider Demographics
NPI:1598814626
Name:MID-PIKE SURGICAL CENTER, L.L.C.
Entity Type:Organization
Organization Name:MID-PIKE SURGICAL CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TRITTO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-881-6222
Mailing Address - Street 1:11801 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2734
Mailing Address - Country:US
Mailing Address - Phone:301-881-6222
Mailing Address - Fax:301-881-1639
Practice Address - Street 1:11801 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2734
Practice Address - Country:US
Practice Address - Phone:301-881-6222
Practice Address - Fax:301-881-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1253261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical