Provider Demographics
NPI:1649393695
Name:COLUMBIA MD ORTHOPAEDIC ASC, LLC
Entity Type:Organization
Organization Name:COLUMBIA MD ORTHOPAEDIC ASC, LLC
Other - Org Name:HICKORY RIDGE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-774-0501
Mailing Address - Street 1:10700 CHARTER DR #301
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4000
Mailing Address - Country:US
Mailing Address - Phone:410-910-2301
Mailing Address - Fax:410-910-2303
Practice Address - Street 1:10700 CHARTER DR #301
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4000
Practice Address - Country:US
Practice Address - Phone:410-910-2301
Practice Address - Fax:410-910-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1388261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21C0001388Medicare ID - Type Unspecified
MD164ZMedicare PIN