Provider Demographics
NPI:1659377166
Name:FOOT SURGI-CENTER OF OWINGS MILLS, LLC
Entity Type:Organization
Organization Name:FOOT SURGI-CENTER OF OWINGS MILLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-363-2233
Mailing Address - Street 1:25 CROSSROADS DR
Mailing Address - Street 2:STE 410
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5439
Mailing Address - Country:US
Mailing Address - Phone:410-363-2233
Mailing Address - Fax:410-363-2235
Practice Address - Street 1:25 CROSSROADS DR
Practice Address - Street 2:STE 410
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5439
Practice Address - Country:US
Practice Address - Phone:410-363-2233
Practice Address - Fax:410-363-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1397261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3768322OtherAETNA HMO
MD406146200Medicaid
P10037OtherINFORMED
MD64190001OtherBCBS
689786OtherNCPPO
109235OtherEMPLOYERS HEALTH PLAN
DCRPIOtherBCBS
7973633OtherAETNA PPO
3768322OtherAETNA HMO
P00200011Medicare ID - Type UnspecifiedRAILROAD MEDICARE
173ZMedicare ID - Type Unspecified