Provider Demographics
NPI:1639290026
Name:JOHNS HOPKINS SURGERY CENTERS SERIES
Entity Type:Organization
Organization Name:JOHNS HOPKINS SURGERY CENTERS SERIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHII
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:105-837-1854
Mailing Address - Street 1:10803 FALLS ROAD, PAVILLION 3
Mailing Address - Street 2:SUITE 2500 C/O LISA ISHII
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20193-4573
Mailing Address - Country:US
Mailing Address - Phone:410-583-7185
Mailing Address - Fax:
Practice Address - Street 1:4924 CAMPBELL BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5908
Practice Address - Country:US
Practice Address - Phone:410-321-1124
Practice Address - Fax:410-321-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherEIN