Provider Demographics
NPI:1689749350
Name:COLUMBIA UROLOGICAL SURGICAL CENTER, L.L.C.
Entity Type:Organization
Organization Name:COLUMBIA UROLOGICAL SURGICAL CENTER, L.L.C.
Other - Org Name:COLUMBIA UROLOGICAL SURGERY CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KISHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-997-5422
Mailing Address - Street 1:11085 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2983
Mailing Address - Country:US
Mailing Address - Phone:410-997-5422
Mailing Address - Fax:410-997-4359
Practice Address - Street 1:11085 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2983
Practice Address - Country:US
Practice Address - Phone:410-997-5422
Practice Address - Fax:410-997-4359
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL MARYLAND UROLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-21
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1142261QA1903X, 261QL0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015ZMedicare PIN