Provider Demographics
NPI:1790791598
Name:ANNAPOLIS SURGERY CENTER, L.L.C.
Entity Type:Organization
Organization Name:ANNAPOLIS SURGERY CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-535-2270
Mailing Address - Street 1:2629 RIVA ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:443-837-0160
Mailing Address - Fax:443-837-0164
Practice Address - Street 1:2629 RIVA ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:443-837-0160
Practice Address - Fax:443-837-0164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1429261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD194ZMedicare PIN