Provider Demographics
NPI:1780687442
Name:POLUN AMERICAN SURGERY CENTER, PC
Entity Type:Organization
Organization Name:POLUN AMERICAN SURGERY CENTER, PC
Other - Org Name:AMERICAN SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:POLUN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-983-8202
Mailing Address - Street 1:10236 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4959
Mailing Address - Country:US
Mailing Address - Phone:301-983-9873
Mailing Address - Fax:301-299-3985
Practice Address - Street 1:10236 RIVER RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4959
Practice Address - Country:US
Practice Address - Phone:301-983-9873
Practice Address - Fax:301-299-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1127261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD330628Medicare PIN