Provider Demographics
NPI:1659748184
Name:SURGCENTER OF THE POTOMAC, LLC
Entity Type:Organization
Organization Name:SURGCENTER OF THE POTOMAC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANTLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VITEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-483-0282
Mailing Address - Street 1:6500 ROCK SPRING DR
Mailing Address - Street 2:100
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1105
Mailing Address - Country:US
Mailing Address - Phone:240-483-0282
Mailing Address - Fax:240-483-0484
Practice Address - Street 1:6500 ROCK SPRING DR
Practice Address - Street 2:100
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1105
Practice Address - Country:US
Practice Address - Phone:240-483-0282
Practice Address - Fax:240-483-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical