Provider Demographics
NPI:1710952841
Name:ANDOCHICK SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:ANDOCHICK SURGICAL CENTER LLC
Other - Org Name:PHYSICIANS SURGERY CENTER OF FREDERICK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANDOCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-620-4200
Mailing Address - Street 1:81 THOMAS JOHNSON COURT
Mailing Address - Street 2:SUITE B
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:240-215-3070
Mailing Address - Fax:240-215-3071
Practice Address - Street 1:81 THOMAS JOHNSON COURT
Practice Address - Street 2:SUITE B
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:240-215-3070
Practice Address - Fax:240-215-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD208200000X261QA1903X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420883800Medicaid
MDF18275Medicare UPIN
MD420883800Medicaid