Provider Demographics
NPI:1851338677
Name:DELAWARE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:DELAWARE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-736-3710
Mailing Address - Street 1:200 BANNING ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3485
Mailing Address - Country:US
Mailing Address - Phone:302-346-4000
Mailing Address - Fax:302-741-0451
Practice Address - Street 1:200 BANNING ST
Practice Address - Street 2:SUITE 110
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3485
Practice Address - Country:US
Practice Address - Phone:302-346-4000
Practice Address - Fax:302-741-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEFSSC-009261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE08-C0001015Medicare PIN
DEA00044Medicare ID - Type UnspecifiedAMBULATORY SURGERY CENTER